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Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis
Objective To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA). Methods Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination th...
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| Published in: | Arthritis and rheumatism 2009-03, Vol.61 (3), p.291-299 |
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| creator | Van den Hout, Wilbert B. Goekoop‐Ruiterman, Yvonne P. M. Allaart, Cornelia F. De Vries‐Bouwstra, Jeska K. M. Hazes, J. Mieke Kerstens, Pit J. S. M. Van Zeben, Derkjen Hulsmans, Harry M. J. De Jonge‐Bok, Johanna M. De Sonnaville, Peter B. J. Dijkmans, Ben A. C. Breedveld, Ferdinand C. |
| description | Objective
To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA).
Methods
Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures.
Results
Average QALYs (ideally 2.00) for groups 1–4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P ≤ 0.05 for group 4 versus groups 1–3). The Time Trade‐Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost‐utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs.
Conclusion
Initial combination therapy with infliximab for patients with recent‐onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions. |
| doi_str_mv | 10.1002/art.24169 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67004406</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>67004406</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-a1e5e55e4da66e8ffc9a0fcce8167187b19e8070325267f3d474c546473c54b93</originalsourceid><addsrcrecordid>eNp1kMtKA0EURBtRTIwu_AHpjYKLSfo1r2UIviAgSFwPnZ47pmUesW8PITs_wW_0S2xN0JWrS10OVUURcs7ZmDMmJtr5sVA8yQ_IkMcijxiX_JAMGWMqknHOB-QE8TVIIWN5TAY8Fyrjkg1JOevQf75_9N7W1m-pbnW9RYu0q6h3oH0DrafonfbwYgGpbelaexu-SDfWr6gDE0Sw6FoET90K-kb7zpY01Fo56y2ekqNK1whn-zsiz7c3i9l9NH-8e5hN55EJtfJIc4ghjkGVOkkgqyqTa1YZAxlPUp6lS55DxlImRSyStJKlSpWJVaJSGc4ylyNytfNdu-6tB_RFY9FAXesWuh6LJA2DKJYE8HoHGtchOqiKtbONdtuCs-J70iJ0L34mDezF3rRfNlD-kfsNA3C5BzQaXVdOt8biLye4CFSWBm6y4za2hu3_icX0abGL_gIIwZDA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67004406</pqid></control><display><type>article</type><title>Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis</title><source>Wiley</source><creator>Van den Hout, Wilbert B. ; Goekoop‐Ruiterman, Yvonne P. M. ; Allaart, Cornelia F. ; De Vries‐Bouwstra, Jeska K. ; M. Hazes, J. Mieke ; Kerstens, Pit J. S. M. ; Van Zeben, Derkjen ; Hulsmans, Harry M. J. ; De Jonge‐Bok, Johanna M. ; De Sonnaville, Peter B. J. ; Dijkmans, Ben A. C. ; Breedveld, Ferdinand C.</creator><creatorcontrib>Van den Hout, Wilbert B. ; Goekoop‐Ruiterman, Yvonne P. M. ; Allaart, Cornelia F. ; De Vries‐Bouwstra, Jeska K. ; M. Hazes, J. Mieke ; Kerstens, Pit J. S. M. ; Van Zeben, Derkjen ; Hulsmans, Harry M. J. ; De Jonge‐Bok, Johanna M. ; De Sonnaville, Peter B. J. ; Dijkmans, Ben A. C. ; Breedveld, Ferdinand C.</creatorcontrib><description>Objective
To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA).
Methods
Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures.
Results
Average QALYs (ideally 2.00) for groups 1–4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P ≤ 0.05 for group 4 versus groups 1–3). The Time Trade‐Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost‐utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs.
Conclusion
Initial combination therapy with infliximab for patients with recent‐onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions.</description><identifier>ISSN: 0004-3591</identifier><identifier>ISSN: 0893-7524</identifier><identifier>EISSN: 1529-0131</identifier><identifier>EISSN: 1529-0123</identifier><identifier>DOI: 10.1002/art.24169</identifier><identifier>PMID: 19248130</identifier><identifier>CODEN: ARCREG</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adult ; Aged ; Antibodies, Monoclonal - administration & dosage ; Antirheumatic Agents - administration & dosage ; Antirheumatic Agents - economics ; Arthritis, Rheumatoid - drug therapy ; Arthritis, Rheumatoid - economics ; Biological and medical sciences ; Cost-Benefit Analysis ; Diseases of the osteoarticular system ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Health Care Costs ; Humans ; Inflammatory joint diseases ; Infliximab ; Male ; Medical sciences ; Middle Aged ; Prednisone - administration & dosage ; Quality-Adjusted Life Years</subject><ispartof>Arthritis and rheumatism, 2009-03, Vol.61 (3), p.291-299</ispartof><rights>Copyright © 2009 by the American College of Rheumatology</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-a1e5e55e4da66e8ffc9a0fcce8167187b19e8070325267f3d474c546473c54b93</citedby><cites>FETCH-LOGICAL-c3539-a1e5e55e4da66e8ffc9a0fcce8167187b19e8070325267f3d474c546473c54b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.24169$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.24169$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21213087$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19248130$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Van den Hout, Wilbert B.</creatorcontrib><creatorcontrib>Goekoop‐Ruiterman, Yvonne P. M.</creatorcontrib><creatorcontrib>Allaart, Cornelia F.</creatorcontrib><creatorcontrib>De Vries‐Bouwstra, Jeska K.</creatorcontrib><creatorcontrib>M. Hazes, J. Mieke</creatorcontrib><creatorcontrib>Kerstens, Pit J. S. M.</creatorcontrib><creatorcontrib>Van Zeben, Derkjen</creatorcontrib><creatorcontrib>Hulsmans, Harry M. J.</creatorcontrib><creatorcontrib>De Jonge‐Bok, Johanna M.</creatorcontrib><creatorcontrib>De Sonnaville, Peter B. J.</creatorcontrib><creatorcontrib>Dijkmans, Ben A. C.</creatorcontrib><creatorcontrib>Breedveld, Ferdinand C.</creatorcontrib><title>Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis</title><title>Arthritis and rheumatism</title><addtitle>Arthritis Rheum</addtitle><description>Objective
To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA).
Methods
Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures.
Results
Average QALYs (ideally 2.00) for groups 1–4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P ≤ 0.05 for group 4 versus groups 1–3). The Time Trade‐Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost‐utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs.
Conclusion
Initial combination therapy with infliximab for patients with recent‐onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions.</description><subject>Adult</subject><subject>Aged</subject><subject>Antibodies, Monoclonal - administration & dosage</subject><subject>Antirheumatic Agents - administration & dosage</subject><subject>Antirheumatic Agents - economics</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Arthritis, Rheumatoid - economics</subject><subject>Biological and medical sciences</subject><subject>Cost-Benefit Analysis</subject><subject>Diseases of the osteoarticular system</subject><subject>Drug Administration Schedule</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Inflammatory joint diseases</subject><subject>Infliximab</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prednisone - administration & dosage</subject><subject>Quality-Adjusted Life Years</subject><issn>0004-3591</issn><issn>0893-7524</issn><issn>1529-0131</issn><issn>1529-0123</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNp1kMtKA0EURBtRTIwu_AHpjYKLSfo1r2UIviAgSFwPnZ47pmUesW8PITs_wW_0S2xN0JWrS10OVUURcs7ZmDMmJtr5sVA8yQ_IkMcijxiX_JAMGWMqknHOB-QE8TVIIWN5TAY8Fyrjkg1JOevQf75_9N7W1m-pbnW9RYu0q6h3oH0DrafonfbwYgGpbelaexu-SDfWr6gDE0Sw6FoET90K-kb7zpY01Fo56y2ekqNK1whn-zsiz7c3i9l9NH-8e5hN55EJtfJIc4ghjkGVOkkgqyqTa1YZAxlPUp6lS55DxlImRSyStJKlSpWJVaJSGc4ylyNytfNdu-6tB_RFY9FAXesWuh6LJA2DKJYE8HoHGtchOqiKtbONdtuCs-J70iJ0L34mDezF3rRfNlD-kfsNA3C5BzQaXVdOt8biLye4CFSWBm6y4za2hu3_icX0abGL_gIIwZDA</recordid><startdate>20090315</startdate><enddate>20090315</enddate><creator>Van den Hout, Wilbert B.</creator><creator>Goekoop‐Ruiterman, Yvonne P. M.</creator><creator>Allaart, Cornelia F.</creator><creator>De Vries‐Bouwstra, Jeska K.</creator><creator>M. Hazes, J. Mieke</creator><creator>Kerstens, Pit J. S. M.</creator><creator>Van Zeben, Derkjen</creator><creator>Hulsmans, Harry M. J.</creator><creator>De Jonge‐Bok, Johanna M.</creator><creator>De Sonnaville, Peter B. J.</creator><creator>Dijkmans, Ben A. C.</creator><creator>Breedveld, Ferdinand C.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090315</creationdate><title>Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis</title><author>Van den Hout, Wilbert B. ; Goekoop‐Ruiterman, Yvonne P. M. ; Allaart, Cornelia F. ; De Vries‐Bouwstra, Jeska K. ; M. Hazes, J. Mieke ; Kerstens, Pit J. S. M. ; Van Zeben, Derkjen ; Hulsmans, Harry M. J. ; De Jonge‐Bok, Johanna M. ; De Sonnaville, Peter B. J. ; Dijkmans, Ben A. C. ; Breedveld, Ferdinand C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-a1e5e55e4da66e8ffc9a0fcce8167187b19e8070325267f3d474c546473c54b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Monoclonal - administration & dosage</topic><topic>Antirheumatic Agents - administration & dosage</topic><topic>Antirheumatic Agents - economics</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Arthritis, Rheumatoid - economics</topic><topic>Biological and medical sciences</topic><topic>Cost-Benefit Analysis</topic><topic>Diseases of the osteoarticular system</topic><topic>Drug Administration Schedule</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Health Care Costs</topic><topic>Humans</topic><topic>Inflammatory joint diseases</topic><topic>Infliximab</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prednisone - administration & dosage</topic><topic>Quality-Adjusted Life Years</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Van den Hout, Wilbert B.</creatorcontrib><creatorcontrib>Goekoop‐Ruiterman, Yvonne P. M.</creatorcontrib><creatorcontrib>Allaart, Cornelia F.</creatorcontrib><creatorcontrib>De Vries‐Bouwstra, Jeska K.</creatorcontrib><creatorcontrib>M. Hazes, J. Mieke</creatorcontrib><creatorcontrib>Kerstens, Pit J. S. M.</creatorcontrib><creatorcontrib>Van Zeben, Derkjen</creatorcontrib><creatorcontrib>Hulsmans, Harry M. J.</creatorcontrib><creatorcontrib>De Jonge‐Bok, Johanna M.</creatorcontrib><creatorcontrib>De Sonnaville, Peter B. J.</creatorcontrib><creatorcontrib>Dijkmans, Ben A. C.</creatorcontrib><creatorcontrib>Breedveld, Ferdinand C.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis and rheumatism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Van den Hout, Wilbert B.</au><au>Goekoop‐Ruiterman, Yvonne P. M.</au><au>Allaart, Cornelia F.</au><au>De Vries‐Bouwstra, Jeska K.</au><au>M. Hazes, J. Mieke</au><au>Kerstens, Pit J. S. M.</au><au>Van Zeben, Derkjen</au><au>Hulsmans, Harry M. J.</au><au>De Jonge‐Bok, Johanna M.</au><au>De Sonnaville, Peter B. J.</au><au>Dijkmans, Ben A. C.</au><au>Breedveld, Ferdinand C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis</atitle><jtitle>Arthritis and rheumatism</jtitle><addtitle>Arthritis Rheum</addtitle><date>2009-03-15</date><risdate>2009</risdate><volume>61</volume><issue>3</issue><spage>291</spage><epage>299</epage><pages>291-299</pages><issn>0004-3591</issn><issn>0893-7524</issn><eissn>1529-0131</eissn><eissn>1529-0123</eissn><coden>ARCREG</coden><notes>Dr. de Sonnaville has received speaking fees (less than $10,000) from Procter and Gamble, and has received research funding from Abbott for the Realise Study.</notes><notes>Dr. Hazes has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from UCB and Wyeth.</notes><notes>Dr. Breedveld has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Schering‐Plough, Abbott, and Wyeth.</notes><notes>Dr. Alaart has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Schering‐Plough.</notes><notes>ISRCTN: 32675862.</notes><notes>Dr. de Vries‐Bouwstra has received speaking fees (less than $10,000) from Schering‐Plough.</notes><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-News-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>Objective
To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA).
Methods
Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures.
Results
Average QALYs (ideally 2.00) for groups 1–4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P ≤ 0.05 for group 4 versus groups 1–3). The Time Trade‐Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost‐utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs.
Conclusion
Initial combination therapy with infliximab for patients with recent‐onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>19248130</pmid><doi>10.1002/art.24169</doi><tpages>9</tpages></addata></record> |
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| ispartof | Arthritis and rheumatism, 2009-03, Vol.61 (3), p.291-299 |
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| subjects | Adult Aged Antibodies, Monoclonal - administration & dosage Antirheumatic Agents - administration & dosage Antirheumatic Agents - economics Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - economics Biological and medical sciences Cost-Benefit Analysis Diseases of the osteoarticular system Drug Administration Schedule Drug Therapy, Combination Female Health Care Costs Humans Inflammatory joint diseases Infliximab Male Medical sciences Middle Aged Prednisone - administration & dosage Quality-Adjusted Life Years |
| title | Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis |
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