RESEARCH - The PsA cost evaluation study: a cost-of-illness study on TNF inhibitors in PsA patients with inadequate response to conventional therapy

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Rheumatology Advance Access originally published online on August 24, 2008

Rheumatology 2008 47(11):1664-1670; doi:10.1093/rheumatology/ken320

The psoriatic arthritis cost evaluation study: a cost-of-illness study

on tumour necrosis factor inhibitors in psoriatic arthritis patients

with inadequate response to conventional therapy

I. Olivieri1, S. de Portu2, C. Salvarani3, A. Cauli4, E. Lubrano5, A.

Spadaro6, F. Cantini7, M. S. Cutro1, A. Mathieu4, M. Matucci-Cerinic8,

N. Pappone5, L. Punzi9, R. Scarpa10, L. G. Mantovani2,11 and for the

PACE working group

1Rheumatology Department of Lucania, San Carlo Hospital of Potenza and

Madonna delle Grazie Hospital of Matera, Potenza and Matera,

2CIRFF/Center of Pharmacoeconomics, Faculty of Pharmacy, University

Federico II of Naples, Naples, 3Rheumatic Disease Unit, Arcispedale S.

Nuova, Reggio Emilia, 4Rheumatology Unit II, University of

Cagliari, Monserrato, 5Rheumatology and Rehabilitation Research Unit,

Fondazione Maugeri IRCCS, Telese Terme, 6Rheumatology Unit, Department

of Medical and Therapeutical Clinic, University " La Sapienza " , Rome,

7Rheumatic Disease Unit, 2nd Division of Medicine, Prato Hospital,

Prato, 8Rheumatology Department, University of Florence, Florence,

9Rheumatology Unit, Department of Clinical and Experimental Medicine,

University of Padova, Padova, 10Rheumatology Research Unit, University

Federico II of Naples, Naples and 11Fondazione Charta, Milan, Italy.

Abstract

Objective. To evaluate costs, benefits and cost–effectiveness of

anti-TNF agents in PsA patients with inadequate response to

conventional treatment.

Methods. A total of 107 patients, from nine Italian rheumatology

centres, with different forms of PsA were given anti-TNF treatment,

mainly etanercept (87%). Information on resource use, health-related

quality of life, disease activity, function and laboratory values were

collected at baseline and through out the 12 months of therapy. Cost

(expressed in euro 2007) and utility (measured by EuroQol) before and

after anti-TNF therapy initiation were compared in order to estimate

the incremental cost per quality-adjusted life year (QALY) gained, and

cost–effectiveness acceptability curve was calculated.

Results. At the end of 12 months, there was a significant increase in

direct cost due to an increase of drug cost caused by TNF inhibitors

that was only partially offset by the decrease in indirect cost. In

the last 6 months of therapy, the direct cost increased by 5052, the

cost for the National Health System (NHS) by 5044 and the social cost

by 4638. However, a gain of 0.12 QALY resulted in a cost per QALY

gained of 40 876 for the NHS and of 37 591 for the society. The

acceptability curve showed that there would be a 97% likelihood that

anti-TNF therapy would be considered cost-effective at

willingness-to-pay threshold of 60 000 per QALY gained.

Conclusion. Cost–effectiveness ratios are within the commonly accepted

willingness-to-pay threshold. These results need to be confirmed in

larger samples of patients.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/11/1664?etoc

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