Re: A cost effectiveness analysis of treatment options for MTX-naive RA

[Guest guest]

,

Glad to see you! I read this, I have no idea what it said (LOL!).

Suzanne

[ ] A cost effectiveness analysis of treatment options for

MTX-naive RA

> J Rheumatol 2002 Jun;29(6):1156-65

>

>

> A cost effectiveness analysis of treatment options for methotrexate-naive

rheumatoid arthritis.

>

> Choi HK, Seeger JD, Kuntz KM.

>

> Department of Medicine, Massachusetts General Hospital, Harvard Medical

School, Boston 02114, USA. HCHOI@...

>

> OBJECTIVE: New treatment options for patients with methotrexate

(MTX)-naive rheumatoid arthritis (RA) have become available. Given wide

variability in efficacy and cost among different treatment options, we

sought to determine their relative cost effectiveness to help guide policy

in different cost constrained settings. METHODS: We performed a cost

effectiveness analysis comparing 5 monotherapy options for patients with

MTX-naive RA: (1) etanercept, (2) leflunomide, (3) MTX (up to 15 mg weekly),

(4) sulfasalazine (SSZ), and (5) no second line agent. A decision analysis

model was used with a time horizon of 6 months. We employed 2 measures of

effectiveness based on published clinical trial data: American College of

Rheumatology (ACR) 20% response proportion (ACR 20) and a weighted average

of proportions achieving ACR 70, ACR 50, and ACR 20 (ACR 70 weighted

response, ACR 70WR). Incremental cost effectiveness ratios were calculated

as additional cost per patient achieving either outcome, compared with the

next most expensive option. RESULTS: In both base case analyses employing

ACR 20 and ACR 70WR as effectiveness measures, MTX and SSZ both cost less

and were more effective (i.e., cost saving) than no second line agent.

Leflunomide cost more and was less efficacious than SSZ (dominated) in

analyses using either outcome. The most efficacious option, etanercept, cost

US $41,900 per ACR 20 and $40,800 per ACR 70 WR compared with SSZ and MTX,

respectively. When we included only direct costs in analyses, the least

expensive non-dominated option was SSZ with incremental cost effectiveness

ratios of US $900 per ACR 20 and $1500 per ACR 70WR compared with no second

line agent. Overall, relative cost effectiveness between MTX and SSZ was

sensitive to variation in relevant variables in sensitivity analyses.

Otherwise, our extensive sensitivity analyses did not substantially affect

the base case results. CONCLUSION: MTX is cost effective (cost saving vs the

no second line agent option) for MTX-naive RA in achieving ACR 20 or ACR

70WR over a 6 month period. Based on available data, the relative cost

effectiveness between SSZ and MTX cannot be determined with reasonable

certainty and SSZ therapy appears to be as cost effective as MTX (cost

saving) in achieving ACR outcomes over a 6 month period. The most

efficacious option, etanercept, incurs much higher incremental costs per ACR

20 or ACR 70WR than other options analyzed. Whether etanercept compared with

MTX is cost effective depends on whether > $40,000 per ACR 20 or ACR 70WR

over a 6 month period is considered acceptable.

>

> PMID: 12064828

>

>

>

>

>

>

[Guest guest]

Hi - I look at these all the time (I work for CDC), maybe I can help. In a

nutshell, they examined the cost effectiveness of treatment for RA that

doesn't respond to methotrexate. They looked at adding Enbrel, Arava, more

MTX, sulfasalazine, and no additional medication. When looking at the

different treatment options compared to the " no other treatment " control,

they found:

1. Enbrel works best, but is very expensive.

2. Additional MTX helps, and is not expensive.

3. Adding Sulphasalazine helps, and is not expensive.

4. Avara is more expensive and not as effective (medically) as adding

Sulphasalazine.

5. Its hard to determine whether MTX or Sulphasalazine is more

cost-effective. Results differ depending on how cost-effectiveness is

measured.

Interesting article. Wish it had something about Kineret or Remicade. Hope

the summary helps -

>From: " Suzanne " <suzshay@...>

>Reply-

>< >

>Subject: Re: [ ] A cost effectiveness analysis of treatment

>options for MTX-naive RA

>Date: Wed, 19 Jun 2002 05:35:14 -0500

>

>,

>

>Glad to see you! I read this, I have no idea what it said (LOL!).

>

>Suzanne

>

> [ ] A cost effectiveness analysis of treatment options

>for

>MTX-naive RA

>

>

> > J Rheumatol 2002 Jun;29(6):1156-65

> >

> >

> > A cost effectiveness analysis of treatment options for

>methotrexate-naive

>rheumatoid arthritis.

> >

> > Choi HK, Seeger JD, Kuntz KM.

> >

> > Department of Medicine, Massachusetts General Hospital, Harvard Medical

>School, Boston 02114, USA. HCHOI@...

> >

> > OBJECTIVE: New treatment options for patients with methotrexate

>(MTX)-naive rheumatoid arthritis (RA) have become available. Given wide

>variability in efficacy and cost among different treatment options, we

>sought to determine their relative cost effectiveness to help guide policy

>in different cost constrained settings. METHODS: We performed a cost

>effectiveness analysis comparing 5 monotherapy options for patients with

>MTX-naive RA: (1) etanercept, (2) leflunomide, (3) MTX (up to 15 mg

>weekly),

>(4) sulfasalazine (SSZ), and (5) no second line agent. A decision analysis

>model was used with a time horizon of 6 months. We employed 2 measures of

>effectiveness based on published clinical trial data: American College of

>Rheumatology (ACR) 20% response proportion (ACR 20) and a weighted average

>of proportions achieving ACR 70, ACR 50, and ACR 20 (ACR 70 weighted

>response, ACR 70WR). Incremental cost effectiveness ratios were calculated

>as additional cost per patient achieving either outcome, compared with the

>next most expensive option. RESULTS: In both base case analyses employing

>ACR 20 and ACR 70WR as effectiveness measures, MTX and SSZ both cost less

>and were more effective (i.e., cost saving) than no second line agent.

>Leflunomide cost more and was less efficacious than SSZ (dominated) in

>analyses using either outcome. The most efficacious option, etanercept,

>cost

>US $41,900 per ACR 20 and $40,800 per ACR 70 WR compared with SSZ and MTX,

>respectively. When we included only direct costs in analyses, the least

>expensive non-dominated option was SSZ with incremental cost effectiveness

>ratios of US $900 per ACR 20 and $1500 per ACR 70WR compared with no second

>line agent. Overall, relative cost effectiveness between MTX and SSZ was

>sensitive to variation in relevant variables in sensitivity analyses.

>Otherwise, our extensive sensitivity analyses did not substantially affect

>the base case results. CONCLUSION: MTX is cost effective (cost saving vs

>the

>no second line agent option) for MTX-naive RA in achieving ACR 20 or ACR

>70WR over a 6 month period. Based on available data, the relative cost

>effectiveness between SSZ and MTX cannot be determined with reasonable

>certainty and SSZ therapy appears to be as cost effective as MTX (cost

>saving) in achieving ACR outcomes over a 6 month period. The most

>efficacious option, etanercept, incurs much higher incremental costs per

>ACR

>20 or ACR 70WR than other options analyzed. Whether etanercept compared

>with

>MTX is cost effective depends on whether > $40,000 per ACR 20 or ACR 70WR

>over a 6 month period is considered acceptable.

> >

> > PMID: 12064828

> >

> >

> >

> >

> >

> >

[Guest guest]

Thanks ,

Why couldn't they have just said it like you did??? I went back and read it

again after I read your summary, I *still* got lost in what they were trying

to say. Goodness, you have to read this stuff at work?? That's quite a

talent you've developed!

Suzanne

[ ] A cost effectiveness analysis of treatment options

> >for

> >MTX-naive RA

> >

> >

> > > J Rheumatol 2002 Jun;29(6):1156-65

> > >

> > >

> > > A cost effectiveness analysis of treatment options for

> >methotrexate-naive

> >rheumatoid arthritis.

> > >

> > > Choi HK, Seeger JD, Kuntz KM.

> > >

> > > Department of Medicine, Massachusetts General Hospital, Harvard

Medical

> >School, Boston 02114, USA. HCHOI@...

> > >

> > > OBJECTIVE: New treatment options for patients with methotrexate

> >(MTX)-naive rheumatoid arthritis (RA) have become available. Given wide

> >variability in efficacy and cost among different treatment options, we

> >sought to determine their relative cost effectiveness to help guide

policy

> >in different cost constrained settings. METHODS: We performed a cost

> >effectiveness analysis comparing 5 monotherapy options for patients with

> >MTX-naive RA: (1) etanercept, (2) leflunomide, (3) MTX (up to 15 mg

> >weekly),

> >(4) sulfasalazine (SSZ), and (5) no second line agent. A decision

analysis

> >model was used with a time horizon of 6 months. We employed 2 measures of

> >effectiveness based on published clinical trial data: American College of

> >Rheumatology (ACR) 20% response proportion (ACR 20) and a weighted

average

> >of proportions achieving ACR 70, ACR 50, and ACR 20 (ACR 70 weighted

> >response, ACR 70WR). Incremental cost effectiveness ratios were

calculated

> >as additional cost per patient achieving either outcome, compared with

the

> >next most expensive option. RESULTS: In both base case analyses employing

> >ACR 20 and ACR 70WR as effectiveness measures, MTX and SSZ both cost less

> >and were more effective (i.e., cost saving) than no second line agent.

> >Leflunomide cost more and was less efficacious than SSZ (dominated) in

> >analyses using either outcome. The most efficacious option, etanercept,

> >cost

> >US $41,900 per ACR 20 and $40,800 per ACR 70 WR compared with SSZ and

MTX,

> >respectively. When we included only direct costs in analyses, the least

> >expensive non-dominated option was SSZ with incremental cost

effectiveness

> >ratios of US $900 per ACR 20 and $1500 per ACR 70WR compared with no

second

> >line agent. Overall, relative cost effectiveness between MTX and SSZ was

> >sensitive to variation in relevant variables in sensitivity analyses.

> >Otherwise, our extensive sensitivity analyses did not substantially

affect

> >the base case results. CONCLUSION: MTX is cost effective (cost saving vs

> >the

> >no second line agent option) for MTX-naive RA in achieving ACR 20 or ACR

> >70WR over a 6 month period. Based on available data, the relative cost

> >effectiveness between SSZ and MTX cannot be determined with reasonable

> >certainty and SSZ therapy appears to be as cost effective as MTX (cost

> >saving) in achieving ACR outcomes over a 6 month period. The most

> >efficacious option, etanercept, incurs much higher incremental costs per

> >ACR

> >20 or ACR 70WR than other options analyzed. Whether etanercept compared

> >with

> >MTX is cost effective depends on whether > $40,000 per ACR 20 or ACR 70WR

> >over a 6 month period is considered acceptable.

> > >

> > > PMID: 12064828

> > >

> > >

> > >

> > >

> > >

> > >