Modelling the cost-effectiveness of Enbrel in adults with RA in the UK

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Rheumatology 2004; 43: 62-72

© British Society for Rheumatology 2003; all rights reserved

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Modelling the cost-effectiveness of etanercept in adults with rheumatoid

arthritis in the UK

A. Brennan, N. Bansback, A. Reynolds1 and P. Conway1

Operational Research, School of Health and Related Research, University

of Sheffield, Sheffield, South Yorkshire and 1Wyeth Laboratories,

Maidenhead, Berkshire, UK.

Correspondence to: A. Brennan. E-mail: A.Brennan@...

Abstract

Objectives. This model examines the cost-effectiveness of etanercept

monotherapy under British Society for Rheumatology guidelines, i.e.

adults previously failing two disease-modifying anti-rheumatic drugs

(DMARDs). It compares a DMARD sequence with etanercept third line

against the same sequence excluding etanercept.

Method. The 6-monthly trend in Health Assessment Questionnaire (HAQ)

disability score is simulated for 10 000 patients' lifetimes using

clinical trial data and published literature. Switching to the next

treatment is triggered by lack of response, loss of efficacy or adverse

events. Patient mortality depends on rheumatoid arthritis life-tables

and on epidemiological evidence relating reduced risk to HAQ

improvement. Regression of HAQ/EuroQol (EQ-5D) utility provides

quality-adjusted life years (QALY) gained. Primary analysis includes

drug costs, monitoring and hospitalizations.

Results. The central estimate cost per QALY is £ 16 330. Sensitivity

analyses (£ 7800 to £ 42 000) showed long-term HAQ progression

(etanercept, DMARDs, non-responders) as most sensitive variables. The

inclusion of potential avoided nursing home admissions and indirect

costs/lost employment further improves the cost-effectiveness.

Conclusions. For adults in the UK, the results suggest that etanercept

is cost-effective when compared with non-biologic agents. The National

Institute for Clinical Excellence has accepted that etanercept is

cost-effective and recommended its availability for use in patients who

have failed at least two DMARDs. This model was an important component

of that decision. The model is further suitable for use for a wide range

of other cost-effectiveness questions in rheumatoid arthritis.

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