Estimating the cost and health status consequences of treatment with TNF antagonists in patients with psoriatic arthritis

Bansback, Nick; Ara, Roberta; Barkham, N.; Brennan, Alan; Fraser, Alexander; Conway, Peter; Reynolds, A. V.; Emery, Paul

doi:10.1093/rheumatology/kel147

Cited by 46 publications

(55 citation statements)

References 27 publications

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“…Previously costeffectiveness models of biologicals assumed linear relationship between functional status (HAQ) and direct costs in PsA based on RA data [12][13]. Huscher et al [4] confirmed this relation of total costs based on a PsA study and our results pointed out the same with HAQ.…”

Section: Discussionsupporting

confidence: 82%

Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment

Brodszky

Bálint

Géher³

et al. 2009

Rheumatol Int

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International audienceThe objectives of this study were to assess the costs of psoriatic arthritis (PsA) in Hungary and to identify key cost drivers among demographic and clinical variables and to compare cost-of-illness of PsA and rheumatoid arthritis (RA). Cross-sectional retrospective survey of 183 consecutive patients from eight rheumatology centres was conducted. Mean direct medical, direct non medical, indirect and total costs were 1,876, 794, 2,904 and 5,574 euros/patient/year, respectively. Total costs were in significant linear relationship with health assessment questionnaire score and psoriatic area severity index. Costs of RA were higher in all domains than of PsA. Our study was the first from the Eastern European region that provides cost-of-illness data on PsA. Our study revealed that functional status and severity of skin symptoms were the key cost drivers. The costs of PsA in Hungary were lower than in the high-income European countries

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Section: Discussionsupporting

confidence: 82%

Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment

Brodszky

Bálint

Géher³

et al. 2009

Rheumatol Int

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“…Direct health-care resources were collected prospectively for all patients for hospitalisations, surgical interventions and RA medications. Based on this study, Bansback et al 130 separately applied a linear regression model to estimate the relationship between HAQ-DI score and resource use (Equation 2). The regression estimates were subsequently reduced by 15% to account for expenditure on DMARDs and to avoid double counting other drug acquisition costs which were separately estimated.…”

Section: Summary Of Resource Utilisation and Costs Data Used In The Ymentioning

confidence: 99%

Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation

Corbett

Chehadah

Biswas

et al. 2017

Health Technol Assess

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BackgroundSeveral biologic therapies are approved by the National Institute for Health and Care Excellence (NICE) for psoriatic arthritis (PsA) patients who have had an inadequate response to two or more synthetic disease-modifying antirheumatic drugs (DMARDs). NICE does not specifically recommend switching from one biologic to another, and only ustekinumab (UST; STELARA®, Janssen Pharmaceuticals, Inc., Horsham, PA, USA) is recommended after anti-tumour necrosis factor failure. Secukinumab (SEC; COSENTYX®, Novartis International AG, Basel, Switzerland) and certolizumab pegol (CZP; CIMZIA®, UCB Pharma, Brussels, Belgium) have not previously been appraised by NICE.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of CZP and SEC for treating active PsA in adults in whom DMARDs have been inadequately effective.DesignSystematic review and economic model.Data sourcesFourteen databases (including MEDLINE and EMBASE) were searched for relevant studies from inception to April 2016 for CZP and SEC studies; update searches were run to identify new comparator studies.Review methodsClinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis (NMA) methods to investigate the relative efficacy of SEC and CZP compared with comparator therapies. A de novo model was developed to assess the cost-effectiveness of SEC and CZP compared with the other relevant comparators. The model was specified for three subpopulations, in accordance with the NICE scope (patients who have taken one prior DMARD, patients who have taken two or more prior DMARDs and biologic-experienced patients). The models were further classified according to the level of concomitant psoriasis.ResultsNineteen eligible RCTs were included in the systematic review of short-term efficacy. Most studies were well conducted and were rated as being at low risk of bias. Trials of SEC and CZP demonstrated clinically important efficacy in all key clinical outcomes. At 3 months, patients taking 150 mg of SEC [relative risk (RR) 6.27, 95% confidence interval (CI) 2.55 to 15.43] or CZP (RR 3.29, 95% CI 1.94 to 5.56) were more likely to be responders than patients taking placebo. The NMA results for the biologic-naive subpopulations indicated that the effectiveness of SEC and CZP relative to other biologics and each other was uncertain. Limited data were available for the biologic-experienced subpopulation. Longer-term evidence suggested that these newer biologics reduced disease progression, with the benefits being similar to those seen for older biologics. The de novo model generated incremental cost-effectiveness ratios (ICERs) for three subpopulations and three psoriasis subgroups. In subpopulation 1 (biologic-naive patients who had taken one prior DMARD), CZP was the optimal treatment in the moderate–severe psoriasis subgroup and 150 mg of SEC was optimal in the subgroups of patients with mild–moderate psoriasis or no concomitant psoriasis. In subpopulation 2 (biologic-naive patients who had taken two or more prior DMARDs), etanercept (ETN; ENBREL®, Pfizer Inc., New York City, NY, USA) is likely to be the optimal treatment in all subgroups. The ICERs for SEC and CZP versus best supportive care are in the region of £20,000–30,000 per quality-adjusted life-year (QALY). In subpopulation 3 (biologic-experienced patients or patients in whom biologics are contraindicated), UST is likely to be the optimal treatment (ICERs are in the region of £21,000–27,000 per QALY). The optimal treatment in subpopulation 2 was sensitive to the choice of evidence synthesis model. In subpopulations 2 and 3, results were sensitive to the algorithm for Health Assessment Questionnaire-Disability Index costs. The optimal treatment is not sensitive to the use of biosimilar prices for ETN and infliximab (REMICADE®, Merck Sharp & Dohme, Kenilworth, NJ, USA).ConclusionsSEC and CZP may be an effective use of NHS resources, depending on the subpopulation and subgroup of psoriasis severity. There are a number of limitations to this assessment, driven mainly by data availability.Future workTrials are needed to inform effectiveness of biologics in biologic-experienced populations.Study registrationThis study is registered as PROSPERO CRD42016033357.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…The update of the results with data records of longitudinal databases will be needed to verify these findings. The analysis of TNF antagonists in Psoriatic Arthritis found that the ETN in patients who have previously failed other treatments DMARD was encouraging; but limitations in available data make it difficult to draw definitive conclusions (44). The results on short-term cost-effectiveness of ETN compared with cyclosporine or LEF are not worthwhile.…”

Section: Economic Evaluations Of the Rheumatic Diseasesmentioning

confidence: 99%

Economic Impact of Rheumatic Diseases

Quintana¹,

Coral-Alvarado²

2011

Challenges in Rheumatology

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Estimating the cost and health status consequences of treatment with TNF antagonists in patients with psoriatic arthritis

Cited by 46 publications

References 27 publications

Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment

Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment

Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation

Economic Impact of Rheumatic Diseases

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