Utility‐based outcomes made easy: The number needed per quality‐adjusted life year gained. An observational cohort study of tumor necrosis factor blockade in inflammatory arthritis from Southern Sweden

Abstract

Objective. To introduce a novel, simple, utility-based outcome measure, the number needed per quality-adjusted life year (QALY) gained (NNQ), and to apply it in clinical practice in anti-tumor necrosis factor (anti-TNF)-treated patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondylarthritis (SpA). Methods. The NNQ is the number of patients one has to treat in order to gain 1 QALY. It is calculated as the inverted value of the utility gain (area under the curve) over 1 year in a cohort subjected to an intervention. EuroQol Index utility data from the South Swedish Arthritis Treatment register were used.

The Costs and Consequences of Adequately Managed Chronic Non‐Cancer Pain and Chronic Neuropathic Pain

“…Ten of the studies (6 medium sized and 4 small; 6,289 patients) were individual patient analyses of one or more randomized trials of long duration (over 8 weeks) or appropriate duration for the condition being treated; one more was a small trial of medium duration (4 weeks; 41 patients) . Two prospective cohort studies of long duration (1 small sized, 1 medium; 1,387 patients) also provided data . Study duration is regarded as an important marker of clinical trial validity, as is not using inappropriate imputation methods .…”

“… activities of daily living or enjoyment of life global impression depression or mood fatigue sleep function ability to work (employment or domestic) quality of life using standard questionnaires …”

“…Only bodily pain did not return to normative values within a 12‐week study duration. Quality‐of‐life benefits were also significant, with EQ‐5D increases over 1 year of 0.22 with successful TNF antagonists in rheumatoid arthritis, 0.35 for ≥ 50% pain intensity reduction in painful diabetic neuropathy, and a 1‐year QALY gain of 0.11 for the same outcome in fibromyalgia . In an analysis of tapentadol trials, patients who tolerated the treatment with tapentadol or oxycodone and completed the trial, and who were therefore likely to be those with good pain benefit, had EQ‐5D average increments of 0.31 .…”

Nonsteroidal Anti‐Inflammatory Drugs, Gastroprotection, and Benefit–Risk

“…The magnitude of the improvements reported is not trivial and is perhaps best explained using the quality‐adjusted life year (QALY), which has a scale from 1 (perfect health for 1 year) to 0 (death). Health status increases over 1 year were 0.22 with successful tumor necrosis factor (TNF) inhibitor in rheumatoid arthritis, 0.35 for ≥ 50% pain intensity reduction in painful diabetic neuropathy, and 0.11 for the same outcome in fibromyalgia . In tapentadol trials in osteoarthritis or chronic low back pain, patients tolerating treatment with tapentadol or oxycodone and completing the trial were likely those with good pain benefit with increments of 0.31 .…”

Biologics-Based Therapy for the Treatment of Rheumatoid Arthritis

“…Observational data from population studies provide useful insights. In Sweden, Gulfe et al 50 reported changes in 1,001 RA patients treated with TNF inhibitors. They found that EuroQol scores improved by a mean of 0.21 (95% CI: 0.19, 0.22).…”