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Study details cost-effectiveness of rheumatoid arthritis treatments for Medicare recipients
Date:4/14/2008

Bank for Rheumatic Diseases. Starting with baseline characteristicsincluding disease duration and score on the disability index of the Health Assessment Questionnaire (HAQ DI)of actual patients treated with each of the targeted biologic drugs, the model simulated a representative sample of 10,000 RA patients. Using these simulated patients, the model assessed the effectiveness of the 4 options, based on the level of American College of Rheumatology (ACR) response and the HAQ DI score for each patient. Beginning after a 6-month course of biology therapy, scores were taken every 6 months until withdrawal, due, for example, to loss of effectiveness or adverse event, and then, assuming a return to DMARD-based therapy, every 6 months throughout the remainder of the patients life. The score for each patient was translated into quality-adjusted life years (QALYs), a measure of benefit that can be used across a wide range of diseases and treatments. The model then calculated the costs incurred for each Medicare patient, including the costs of the biologic drugs, physician visits, other medications, hospitalizations, radiographs, and laboratory work. Finally, the researchers compared the costs and QALYs generated by each of the 4 biologic agents.

In all simulations, anakinra was found to generate less QALYs than the TNF inhibitors. Excluding anakinra to compare the costs of the 3 almost equally effective drug strategies, researchers used a range of $0 to $200,000 as the values a decision-maker may be willing to pay per additional QALY gained. Infliximab was the optimal strategy in only a handful of the simulations. If society were willing to pay as much as $50,000 per QALY, the probability that infliximab would be cost-effective is less than 1 percent.

Our analysis suggests that the use of etanercept or adalimumab in place of infliximab as a first-line biologic agent is likely to be considered cost effective, concludes the studys lead aut
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Contact: Sean Wagner
swagner@bos.blackwellpublishing.com
781-388-8550
Wiley-Blackwell
Source:Eurekalert

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