4CPS-086 Inhaled sedation with halogenated agents in the intensive care unit: a literature mini-review

Abstract

methods We built a cost-effectiveness model based on meta-analyses (direct or indirect) conducted between 2015 and 2021. We gathered all the effectiveness information (American College of Rheumatology (ACR)) through a PICO-S strategy including infliximab, etanercept, certolizumab, tocilizumab, golimumab, tofacitinib and upadacitinib. Two reviewers evaluated the inclusion of the studies and assessed their quality using the PRISMA-NMA Checklist. Efficiency score was cost per number needed to treat (NNT) versus placebo (PLC). The model was designed from a hospital perspective (only direct costs) and with a 1-year horizon. Cost data (C ¼ 2021) were obtained from Spanish datasets and literature review. Using all this information, a cost-effectiveness analysis between ADA and the suitable alternatives was performed. A probabilistic sensitivity analysis (PSA) was performed.Results Two meta-analyses met the inclusion criteria and fulfilled on average 70.6% of the 32 points on the PRISMA-NMA Checklist of items. Tarp et al (2017) showed no statistically significant difference in NNT between infliximab, ADA, etanercept, certolizumab, tocilizumab and golimumab for ACR-50. Song et al (2019) showed no significant difference in NNT between ADA, tofacitinib and upadacitinib for ACR-20.Total annual cost was C ¼ 4529 ADA versus C ¼ 4650-C ¼ 10 001 for the other treatments. As no effectiveness difference was seen, a cost minimisation analysis was performed. Hence ADA was the most cost-effective treatment. In the PSA, only ADA and infliximab performed as the best alternative, with ADA showing the highest probability of being cost-effective. Conclusion and relevanceAccording to our model, ADA was the most cost-effective option for RA treatment in Spain.