RESEARCH - The cost effectiveness of Humira in the treatment of moderate to severe RA

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Ann Rheum Dis. 2004 Nov 18; [Epub ahead of print]

The cost effectiveness of adalimumab in the treatment of moderate to

severe rheumatoid arthritis patients in Sweden.

Bansback N, Brennan A, Ghatnekar O.

School of Health and Related Research, University of Sheffield, UK.

OBJECTIVE: Societal decision-makers increasingly emphasize their need

for evidence-based economic analyses to make reimbursement decisions.

The goal of this study was to analyse the cost utility of adalimumab, on

both incremental cost and incremental health-value bases, vs.

traditional disease-modifying antirheumatic drugs (DMARDs) and the other

tumour necrosis factor (TNF) antagonists suitable for a submission to

the Swedish LFN (Pharmaceutical Benefit Board). Adalimumab (Humira®,

Abbott Laboratories) is a fully human anti-TNF monoclonal antibody for

the treatment of rheumatoid arthritis (RA). METHODS: This study

implemented Swedish unit costs and treatment guidelines from a lifetime

perspective. A mathematical model, incorporating data from eight trials

on efficacy, utility and cost, simulated the experiences of 10,000

hypothetical moderate to severe RA patients for each strategy used in

those trials. The primary outcome measure, quality- adjusted life years

(QALYs), was derived from utility values calculated from a relationship

between the Health Assessment Questionnaire (HAQ) disability index (DI)

and Health Utility Index-3 (HUI-3) from adalimumab trial results. The

model followed OMERACT guidance for incorporating mortality data,

accounting for placebo, trending HAQ DI scores over different periods of

a treatment cycle, and other factors. RESULTS: In a cost-per-ACR50

analysis, adalimumab plus methotrexate showed the greatest number of

QALYs gained (2.3 from one study and 2.1 from the pooled results of two

trials). The etanercept plus methotrexate strategy yielded QALY gains

similar to the pooled adalimumab results. Except for the infliximab

strategy, the costs results are between ? 35,000-42,000, a range

normally considered cost-effective in other European countries.

CONCLUSION: Adalimumab is cost-effective for the treatment of moderate

to severe RA. The results suggest that adalimumab is at least as

cost-effective as the other TNF antagonists.

PMID: 15550533

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