In:
Arthritis & Rheumatology, Wiley, Vol. 70, No. 10 ( 2018-10), p. 1557-1564
Abstract:
To evaluate, from a societal perspective, the incremental cost‐effectiveness of withdrawing tumor necrosis factor inhibitor ( TNF i) treatment compared to continuation of these drugs within a 1‐year, randomized trial among rheumatoid arthritis patients with longstanding, stable disease activity or remission. Methods Data were collected from a pragmatic, open‐label trial. Cost‐utility analysis was performed using the nonparametric bootstrapping method, and a cost‐effectiveness acceptability curve was constructed using the net‐monetary benefit framework, where a willingness‐to‐accept threshold ( WTA ) was defined as the minimal cost saved that a patient accepted for each quality‐adjusted life year ( QALY ) lost. Results A total of 531 patients were randomized to the stop group and 286 patients to the continuation group. Withdrawal of TNF i treatment resulted in a 〉 60% reduction of the total drug cost, but led to an increase of ∼30% in other health care expenditures. Compared to continuation, stopping TNF i resulted in a mean yearly cost saving of €7,133 (95% confidence interval [95% CI ] €6,071, €8,234] ) and was associated with a mean loss of QALY s of 0.02 (95% CI 0.002, 0.040). Mean saved cost per QALY lost and per extra flare incurred in the stop group compared to the continuation group was €368,269 (95% CI €155,132, €1,675,909) and €17,670 (95% CI €13,650, €22,721), respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNF i treatment is cost‐effective was 100%. Conclusion Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on willingness to pay.
Type of Medium:
Online Resource
ISSN:
2326-5191
,
2326-5205
DOI:
10.1002/art.2018.70.issue-10
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2754614-7
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