RESEARCH - Biologic drugs for RA in the Medicare program: a cost-effectiveness analysis

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Arthritis Rheum. 2008 Apr;58(4):939-46.

Biologic drugs for rheumatoid arthritis in the Medicare program: a

cost-effectiveness analysis.

Wailoo AJ, Bansback N, Brennan A, Michaud K, Nixon RM, Wolfe F.

Health Economics and Decision Science, ScHARR, University of

Sheffield, Sheffield, UK.

OBJECTIVE: Since the introduction of the Medicare Prescription Drug

Improvement and Modernization Act and its associated demonstration

project, coverage of selected biologic drugs has been expanded for

Medicare beneficiaries. For rheumatoid arthritis, coverage was

extended to etanercept, adalimumab, and anakinra in addition to the

previously covered infliximab. We undertook to develop a model to

compare the costs and quality-adjusted life years (QALYs) generated by

each of the 4 biologic agents.

METHODS: Data were drawn from meta-analysis of randomized controlled

trials and from a large longitudinal outcomes databank. Uncertainty

was addressed using probabilistic and one-way sensitivity analyses. A

lifetime horizon and Medicare viewpoint were adopted.

RESULTS: In the base case analysis, anakinra was the least effective

and least costly strategy. Etanercept, adalimumab, and infliximab were

similar in terms of effectiveness, but infliximab was more costly. If

decision makers are willing to pay a maximum of $50,000/QALY, the

probability that infliximab is cost-effective is <1%. Findings were

robust to a range of sensitivity analyses. Only if the dose of

infliximab remains constant over time is this likely to be a

cost-effective strategy.

CONCLUSION: Infliximab is unlikely to be cost-effective in the

Medicare population compared with either etanercept or adalimumab.

Anakinra is substantially less costly but is also less effective than

the 3 tumor necrosis factor alpha inhibitors.

PMID: 18383356

http://www.ncbi.nlm.nih.gov/pubmed/18383356

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