Value of the time trade off method for measuring utilities in patients with 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 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.

Section: Utilities and Qalysmentioning

confidence: 99%

Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis

Goekoop-Ruiterman

Allaart

Vries-Bouwstra

et al. 2009

“…Because the RS has repeatedly been found to render less favorable valuations than more valid (but also more complicated) utility measures (40,41), transformed rating scale (TRS) values were obtained using the power function TRS ϭ 1-(1-RS/ 100) 1.61 . Because patients experience all the subtleties of their health status, the TRS is potentially more sensitive to change, but it is not preferred for economic evaluations from a societal perspective (42).…”

Section: Assessments Of Utilitymentioning

confidence: 99%

Cost‐utility analysis of a multidisciplinary job retention vocational rehabilitation program in patients with chronic arthritis at risk of job loss

Buck

Vlieland

2007

Objective. To estimate from a societal perspective the cost-utility of a multidisciplinary job retention vocational rehabilitation program compared with usual care in patients with chronic rheumatic diseases at risk of job loss. Methods. Patients (n ‫؍‬ 121) were randomly assigned to either the vocational rehabilitation program or usual outpatient care initiated by the treating rheumatologist. Followup lasted for 2 years. Program costs were estimated using time registrations and other societal costs using quarterly cost questionnaires filled out by the patients. To estimate qualityadjusted life years, utility was assessed using the EuroQol classification system, EuroQol rating scale, Short Form 6D, and Time Trade-Off. Results. As part of the vocational rehabilitation program, patients on average had a total of 7.1 consultations and the total time spent by the multidisciplinary team was 12.7 hours per patient. Program costs were estimated at €1,426, of which ϳ20% were time and travel costs incurred by the patients. No significant differences were found in other health care consumption, productivity, or quality-adjusted life years. Program costs were outweighed by total savings on other health care and nonhealth care costs, but not significantly. Conclusion. From a societal perspective, it remains unclear whether the program reduces or increases total costs. Further research on effective vocational rehabilitation is warranted, with special attention to early detection of work problems and the collaboration between health care and vocational rehabilitation services.

“…Patients rated their personal health using a visual analog scale (VAS) ranging from worst imaginable health to best imaginable health. Because the VAS has repeatedly been found to render less favorable valuations than more valid (but also more complicated) utility measures, the obtained VAS values were transformed using the power function 1-(1-VAS) 1.61 (18,19). Because patients experience all the subtleties of their health status, the VAS is potentially more sensitive to change, but it is not preferred for economic evaluations from a societal perspective (20).…”

Section: Assessments Of Utilitymentioning

confidence: 99%

Cost‐utility and cost‐effectiveness analyses of a long‐term, high‐intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis

Hout¹,

Jong²,

Munneke³

et al. 2005

Objective. To estimate the cost utility and cost effectiveness of long-term, high-intensity exercise classes compared with usual care in rheumatoid arthritis (RA) patients. Methods. RA patients (n ‫؍‬ 300) were randomly assigned to either exercise classes or UC; followup lasted for 2 years. $1.05). The increase per patient in total medical costs of physical therapy was estimated at €430 (95% CI €318, 577), and the increase in total societal costs at €602 (95% CI €؊490, 1,664). For societal willingness-to-pay equal to €50,000 per QALY, usual care had better cost utility than exercise classes, and significantly so according to the VAS. Conclusion. From a societal perspective and without taking possible preventive health effects into account, long-term, high-intensity exercise classes provide insufficient improvement in the valuation of health to justify the additional costs.