The cost-effectiveness of etanercept and infliximab for the treatment of patients with psoriatic arthritis

Vergel, Yolanda Bravo; Hawkins, Neil; Claxton, K.; Asseburg, Christian; Palmer, Stephen; Woolacott, Nerys; Bruce, Ian N.; Sculpher, Mark

doi:10.1093/rheumatology/kem221

Cited by 53 publications

(63 citation statements)

References 36 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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“…The increase of the antigen -"antigen rebound" -has been sparsely studied and only anecdotal reports exist in the literature. For example, rebound symptoms have been reported on cessation of anti-tumour necrosis factor (TNF) therapies (Bravo Vergal et al, 2007) and a corresponding increase in TNF levels have been demonstrated to occur in patients (Bhatia and Kast, 2007). Similarly, treatment with an anti-IL6 antibody has also been shown to increase total IL6 activity (Klein et al, 1995) and an increase in tumour size on cessation of VEGF treatment has also been reported (Cacheux et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

A mathematical analysis of rebound in a target-mediated drug disposition model: I.Without feedback

Aston

Derks

Agoram³

et al. 2013

J. Math. Biol.

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We consider the possibility of free receptor (antigen/cytokine) levels rebounding to higher than the baseline level after one or more applications of an antibody drug using a target-mediated drug disposition model. Using geometry and dynamical systems analysis, we show that rebound will occur if and only if the elimination rate of the drug-receptor product is slower than the elimination rates of the drug and of the receptor. We also analyse the magnitude of rebound through approximations and simulations and demonstrate that it increases if the drug dose increases or if the difference between the elimination rate of the drug-receptor product and the minimum of the elimination rates of the drug and of the receptor increases.

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“…Several cost analysis studies have implied cost-effectiveness of anti-TNF therapies in AS and PsA patients with moderate to severe disease. [133][134][135][136] However, there have been no headto-head pharmacoeconomic studies of etanercept in comparison with other biologic therapies or traditional DMARDS. Furthermore, it is very diffi cult to estimate cost-effectiveness of long-term therapies in chronic diseases, with short-term data often having to be mathematically modeled over a patient's lifetime.…”

Section: Patient Focused Perspectivesmentioning

confidence: 99%

“…138 In a mathematical model investigating the cost-effectiveness of both etanercept and infl iximab for the treatment of active PsA from a UK National Health Service perspective, only etanercept was found to be potentially cost-effective over a 10-year and lifetime horizon. 135 In a cost evaluation study of 107 PsA patients from Italian rheumatology clinics who were unresponsive to DMARD therapy and treated with TNF antagonists (87% etanercept) for 12 months, there was a 97% likelihood that anti-TNF therapy would be considered cost effective at the willingness to pay threshold of €60,000 per QALY gained. 136 Therefore, based on currently available pharmacoeconomic data, one can speculate that over time, that the indirect and direct cost savings including a reduced need for joint replacement surgeries, decreased health care utilization, diminished need for other medications and therapies, improved quality of life, decreased work disability, and increased life expectancy in AS and PsA patients could be substantial.…”

Section: Patient Focused Perspectivesmentioning

confidence: 99%

The Treatment of Ankylosing Spondylitis and Psoriatic Arthritis with Etanercept: A Comprehensive Review

Collamer

Battafarano

2009

Clinical Medicine. Therapeutics

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Etanercept is a dimeric recombinant soluble tumor necrosis factor (TNF) receptor protein utilized in the treatment of various infl ammatory diseases, including ankylosing spondylitis and psoriatic arthritis. Etanercept binds the proinfl ammatory cytokine TNF and blocks its interaction with soluble TNF receptors, thus decreasing the infl ammatory response. Several randomized controlled clinical trials have demonstrated the effi cacy, safety and tolerability of etanercept in the treatment of both ankylosing spondylitis and psoriatic arthritis. These trials have also shown signifi cant reductions in markers of systemic infl ammation and improvements in patient-reported quality of life measures. Inhibition of radiographic progression has been established in etanercept-treated psoriatic arthritis patients, and ankylosing spondylitis patients have demonstrated decreases in bony infl ammation; however, current data does not support a reduction in bone proliferation in ankylosing spondylitis patients. Concerns regarding long-term toxicity, effi cacy, and cost-effectiveness considerations persist and guidelines have been published to assist the clinician with appropriate patient selection for this biologic therapy. Current data indicates etanercept therapy has been a very successful and well-tolerated therapy for numerous ankylosing spondylitis and psoriatic arthritis patients and will likely continue to be a cornerstone therapy for treatment of these challenging diseases in the foreseeable future.

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The cost-effectiveness of etanercept and infliximab for the treatment of patients with psoriatic arthritis

Cited by 53 publications

References 36 publications

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

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

A mathematical analysis of rebound in a target-mediated drug disposition model: I.Without feedback

The Treatment of Ankylosing Spondylitis and Psoriatic Arthritis with Etanercept: A Comprehensive Review

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