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Comparison of the cost-effectiveness of infliximab in the treatment of ankylosing spondylitis in the United Kingdom based on two different clinical trials

Published online by Cambridge University Press:  19 June 2007

Gisela Kobelt ,
Patrik Sobocki ,
Joachim Sieper  and
Jürgen Braun
Gisela Kobelt
Affiliation:
University of Lund and European Health Economics
Patrik Sobocki
Affiliation:
European Health Economics
Joachim Sieper
Affiliation:
University Medicine Berlin
Jürgen Braun
Affiliation:
Berlin University and Rheumazentrum Ruhrgebiet
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Abstract

Objectives: To compare the cost-effectiveness of the treatment of ankylosing spondylitis (AS) with infliximab in the United Kingdom over lifetime estimated from two different clinical trials and adjusted for clinical practice guidelines.

Methods: A cost-effectiveness model was developed to incorporate clinical, epidemiological, and economic data and allow extrapolation of trial results and incorporation of long-term treatment. Assumptions regarding treatment beyond the trials were based on open extensions from the trials and treatment guidelines by the British Society for Rheumatology. Results are presented for both the societal perspective and the perspective of the National Health Service (UK £, discounted 3.5 percent).

Results: Under the assumption that disease activity would be controlled and functional capacity would remain stable while on drug, treatment with infliximab (5 mg/kg every 6 weeks) dominates standard treatment in the societal perspective. In the National Health Service perspective, the cost per quality-adjusted life-year (QALY) gained over lifetime was £28,300 and £26,800 for the two trials. If functional capacity were to deteriorate at half the rate of untreated patients, the cost per QALY gained would be £35,300 and £34,100, respectively. The results are sensitive to the dosing regimen adopted, the discontinuation rate, and assumptions concerning disease progression while on treatment.

Conclusions: The two clinical trials yield the same cost-effectiveness results and the cost per QALY gained with treatment was found to be in the acceptable range.

Keywords

Cost-effectivenessQALYInfliximabAnkylosing spondylitisUnited Kingdom
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 3 , July 2007 , pp. 368 - 375
Copyright
© 2007 Cambridge University Press

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References

Baraliakos X, Listing J, Brandt J, et al. 2005 Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther. 7: R439– R444.Google Scholar
Baraliakos X, Listing J, Rudwaleit M, et al. 2005 Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor alpha antibody infliximab. Ann Rheum Dis. 64: 1462– 1466.Google Scholar
Boonen A. 2002 Socioeconomic consequences of ankylosing spondylitis. Clin Exp Rheumatol. 20 (Suppl): 23– 26.Google Scholar
Boonen A, van der Heijde D, Landewe R, et al. 2002 Work status and productivity costs due to ankylosing spondylitis: Comparison of three European countries. Ann Rheum Dis. 61: 429– 437.Google Scholar
Boonen A, van der Heijde D, Severens JL, et al. 2006 Markov model into the cost-utility over five years of etanercept and infliximab compared with usual care in patients with active ankylosing spondylitis. Ann Rheum Dis. 65: 201– 208.Google Scholar
Braun J, Baraliakos X, Brandt J, et al. 2005 Persistent clinical response to the anti-TNF-alpha antibody infliximab in patients with ankylosing spondylitis over 3 years. Rheumatology (Oxford). 44: 670– 676.Google Scholar
Braun J, Brandt H, Listing J, et al. 2005 Two-year maintenance of efficacy and safety of infliximab in the treatment of ankylosing spondylitis. Ann Rheum Dis. 64: 229– 234.Google Scholar
Braun J, Brandt J, Listing J, et al. 2002 Treatment of active ankylosing spondylitis with infliximab: A randomised controlled multicentre trial. Lancet. 359: 1187– 1193.Google Scholar
Braun J, Davis J, Dougados M, et al. 2006 First update of the international ASAS consensus statement for the use of anti-TNF agents in patients with ankylosing spondylitis. Ann Rheum Dis. 65: 316– 320.Google Scholar
Calin A, Barrett S, Whitelock H, et al. 1994 A new approach to defining functional ability in ankylosing spondylitis: The development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 21: 2281– 2285.Google Scholar
Carmona L, Gomez-Reino JJ. 2006; Survival of TNF antagonists in spondylarthritis is better than in rheumatoid arthritis: Data from the Spanish registry BIOBADASER. Arthritis Res Ther. 8: R72.Google Scholar
Collantes-Estevez E, Munoz-Villanueva M, Zarco P, et al. 2003 Infliximab in refractory spondylarthropathies: A multicenter 38-week open study. Ann Rheum Dis. 62: 1239– 1240.Google Scholar
Collantes-Estevez E, Munoz-Villanueva M, Zarco P, et al. 2005 Effectiveness of reducing infliximab dose interval in non-responder patients with refractory spondylarthropathies. An open extension of a multicentre study. Rheumatology (Oxford). 44: 1555– 1558.Google Scholar
Dagfinrud H, Mengshoel A, Hagen K, et al. 2004 Health status of patients with ankylosing spondylitis> a comparison with the general population. Ann Rheum Dis. 63: 1605– 1610.Google Scholar
Dolan P, Gudex C, Kind P, Williams A. 1995. A social tariff for EuroQol: Results from a UK general population survey. Discussion Paper 138. York: Centre for Health Economics, University of York;
EuroQol, Group. 1990 EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 16: 199– 208.
Garrett S, Jenkinson T, Kennedy L, et al. 1994 A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing spondylitis Disease Activity Index. J Rheumatol. 21: 2286– 2291.Google Scholar
Hurst N, Kind P, Ruta D, et al. 1997 Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol. 36: 551– 559.Google Scholar
Jois RN, Leeder L, Gibb A, et al. 2006 Low-dose infliximab treatment for ankylosing spondylitis–clinically- and cost-effective. Rheumatology (Oxford). 45: 1566– 1569.Google Scholar
Keeling S, Oswald A, Russell AS, Maksymowych WP. 2006 Prospective observational analysis of the efficacy and safety of low-dose (3 mg/kg) infliximab in ankylosing spondylitis: 4-year followup. J Rheumatol. 33: 558– 561.Google Scholar
Kobelt G, Andlin-Sobocki P, Brophy S, et al. 2004 The burden of ankylosing spondylitis and the cost-effectiveness of treatment with infliximab. Rheumatology (Oxford). 43: 1158– 1166.Google Scholar
Kobelt G, Andlin-Sobocki P, Rousseau C, Maksymowych W. 2006 Cost and quality of life of patients with Ankylosing Spondylitis in Canada. J Rheumatol. 33: 289– 295.Google Scholar
Kobelt G, Lindgren P, Lindroth Y, et al. 2005 Modelling the effect of function and disease activity on costs and quality of life in rheumatoid arthritis. Rheumatology (Oxford). 44: 1169– 1175.Google Scholar
Kristensen LE, Saxne T, Geborek P. 2006 The LUNDEX, a new index of drug efficacy in clinical practice: Results of a five-year observational study of treatment with infliximab and etanercept among rheumatoid arthritis patients in southern Sweden. Arthritis Rheum. 54: 600– 606.Google Scholar
Myckatyn S, Mallon C, Russell A, Maksymowych W. 2004 3 Year follow-up of a prospective observational inception cohort of ankylosing spondylitis patients on low-dose (3 mg/kg) infliximab. Ann Rheum Dis. 63 (Suppl 1): 408.Google Scholar
BSR guidelines for prescribing TNF-alpha blockers in adults with Ankylosing Spondylitis. Available at: http://www.rheumatology.org.uk/guidelines/clinicalguidelines. Accessed 2005.
Taylor A, Balakrishnan C, Calin A. 1998 Reference centile charts for measures of disease activity, functional impairment, and metrology in ankylosing spondylitis. Arthritis Rheum. 41: 1119– 1125.Google Scholar
VanderHeijde D, Dijkmans B, Geusens P, et al. 2005 Efficacy and safety of infliximab in patients with ankylosing spondylitis: Results of a randomized placebo/controlled trial (ASSERT). Arthritis Rheum. 52: 582– 591.Google Scholar
Ward M. 1999 Health-related quality of life in ankylosing spondylitis: A survey of 175 patients. Arthritis Care Res. 12: 247– 255.Google Scholar
Ward MM. 2002 Functional disability predicts total costs in patients with ankylosing spondylitis. Arthritis Rheum. 46: 223– 231.Google Scholar
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