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

[Guest guest]

Hello, and Suzanne! The abstract I sent isn't the easiest thing in the

world to make sense of. Thanks for summarizing, .

I'd like to add two clarifications: 1) " MTX-naive " RA patients are those who

have never been on methotrexate, not those who haven't responded to methotrexate

(usually patients with early RA) 2) " no second-line agent " translates best to

" no DMARD " - choosing not to use a DMARD has implications when considering the

cost effectiveness of treatment options for an RA patient.

[ ] 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 ,

I wondered what " MTX-naive " meant.

Suzanne

> Hello, and Suzanne! The abstract I sent isn't the easiest thing in

the world to make sense of. Thanks for summarizing, .

>

> I'd like to add two clarifications: 1) " MTX-naive " RA patients are those

who have never been on methotrexate, not those who haven't responded to

methotrexate (usually patients with early RA) 2) " no second-line agent "

translates best to " no DMARD " - choosing not to use a DMARD has implications

when considering the cost effectiveness of treatment options for an RA

patient.

>

>

>