Two-year cost effectiveness between two gradual tapering strategies in rheumatoid arthritis: cost-utility analysis of the TARA trial

Mulligen, Elise van; Weel, A.; Kuijper, M.; Denissen, N. H. A. M.; Gerards, A.; Jager, Mike H. de; Lam-Tse, Wai-Kwan; Hazes, Johanna M. W.; Mil, Annette H M van der Helm-van; Jong, Pascal H P de; Luime, Jolanda J.

doi:10.1136/annrheumdis-2020-217528

Cited by 13 publications

(8 citation statements)

References 22 publications

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“…It had previously been suggested to start with a reduction of bDMARDs because of the costs involved. However, an economic analysis has revealed that the total costs of tapering csDMARDs first vs tapering anti-TNFs first did not differ 60. Consequently, the Task Force was of the opinion that there is no preferred tapering sequence and this can be left to the discretion of patients and rheumatologists in a shared decision, but still with an open eye on costs, since prices of bDMARDs may vary significantly within and between countries.…”

Section: Resultsmentioning

confidence: 99%

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

et al. 2022

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ObjectivesTo provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field.MethodsAn international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs). The new evidence was discussed in light of the last update from 2019. A predefined voting process was applied to each overarching principle and recommendation. Levels of evidence and strengths of recommendation were assigned to and participants finally voted on the level of agreement with each item.ResultsThe task force agreed on 5 overarching principles and 11 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); GCs; biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab including biosimilars), abatacept, rituximab, tocilizumab, sarilumab and targeted synthetic (ts) DMARDs, namely the Janus kinase inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib. Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering in sustained clinical remission is provided. Safety aspects, including risk of major cardiovascular events (MACEs) and malignancies, costs and sequencing of b/tsDMARDs were all considered. Initially, MTX plus GCs is recommended and on insufficient response to this therapy within 3–6 months, treatment should be based on stratification according to risk factors; With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD should be added to the csDMARD; after careful consideration of risks of MACEs, malignancies and/or thromboembolic events tsDMARDs may also be considered in this phase. If the first bDMARD (or tsDMARD) fails, any other bDMARD (from another or the same class) or tsDMARD (considering risks) is recommended. With sustained remission, DMARDs may be tapered but should not be stopped. Levels of evidence and levels of agreement were high for most recommendations.ConclusionsThese updated EULAR recommendations provide consensus on RA management including safety, effectiveness and cost.

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Section: Resultsmentioning

confidence: 99%

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

et al. 2022

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“…The probability of being cost-effective at a WTP level of €50 000 was 30.2, 38.7 and 31.1% for, respectively, iMTX, iHCQ and iGCs. This indicates that for the Dutch WTP level of €50 000, iHCQ has the highest chance of being cost-effective [ 16–18 , 27 ]. For WTP levels >€25 600 iHCQ has the highest probability of being cost-effective, while iMTX and iGCs had the highest probability of being cost-effective ≤€25 600 ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Cost-effectiveness acceptability curves were made to decide which initial treatment strategy had the highest chance of being cost-effective for different willingness-to-pay (WTP) levels. WTP thresholds for coverage of drugs differ per country and as mentioned previously the Dutch threshold is €50 000 [ 16–18 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Comparing cost-utility of DMARDs in autoantibody-negative rheumatoid arthritis patients

Luurssen-Masurel

Elise

et al. 2021

Rheumatology

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Objectives To evaluate the 1-year cost-effectiveness between three different initial treatment strategies in autoantibody-negative rheumatoid arthritis(RA-) patients, according to 2010 criteria. Materials and methods For this analysis we selected all RA- patients within the intermediate probability stratum of the tREACH trial. The tREACH had a treat-to-target approach, aiming for low disease activity(DAS<2.4) and treatment adjustments could occur every 3 months. Initial treatment strategies consisted of methotrexate 25mg/week(iMTX), hydroxychloroquine 400mg/day(iHCQ) or an oral glucocorticoids tapering scheme without DMARDs(iGCs). Data on Quality adjusted life-years(QALYs), measured with the EQ-5D-3L, healthcare and productivity costs were used. Results Average QALYs(sd), for iMTX, iHCQ and iGCs were respectively 0.71(0.14), 0.73(0.14) and 0.71(0.15). The average total costs(sd) for iMTX, iHCQ and iGCs were respectively €10.832(14.763), €11.208 (12.801) and €10.502(11.973). Healthcare costs were mainly determined by biological costs, which were significantly lower in the iHCQ group compared to iGCs(p<.05). However, costs due to presenteeism were the highest in the iHCQ group(55%) followed by iMTX(27%) and iGCs(18%). The incremental cost-effectiveness ratios(ICERs) did not differ between treatment strategies. At a willingness-to-pay level of €50.000, the Dutch threshold for reimbursement of medical care, iHCQ had the highest probability(38.7%) of being cost-effective, followed by iGCs(31.1%) and iMTX(30.2%). Conclusions iHCQ had the lowest healthcare and highest productivity costs, resulting in a non-significant ICER. However, iHCQ had the highest chance of being cost-effective at the Dutch WTP-threshold for healthcare reimbursement. Therefore, we believe that iHCQ is a good alternative for iMTX in autoantibody-negative RA patients, but validation is needed. Clinical trial registration number ISRCTN26791028

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“…Schwarzkopf et al 24 found that, in the scenario of depression, the proportion of productivity loss in the total cost could be as high as 81%. Two studies found that productivity loss caused by rheumatoid arthritis accounted for 76% and 54% of the total costs, respectively 25 26. Even influenza, a common infectious disease, might cause significant productivity loss, accounting for about 57% of the total cost 27…”

Section: Resultsmentioning

confidence: 99%

Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide for research agenda in China

et al. 2022

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IntroductionProductivity loss may contribute to a large proportion of costs of health conditions in an economic evaluation from a societal perspective, but there is currently a lack of methodological consensus on how productivity loss should be measured and valued. Despite the research progress surrounding this issue in other countries, it has been rarely discussed in China.MethodsWe reviewed the official guidelines on economic evaluations in different countries and regions and screened the literature to summarise the extent to which productivity loss was incorporated in economic evaluations and the underlying methodological challenges.ResultsA total of 48 guidelines from 46 countries/regions were included. Although 32 (67%) guidelines recommend excluding productivity loss in the base case analysis, 23 (48%) guidelines recommend including productivity loss in the base case or additional analyses. Through a review of systematic reviews and the economic evaluation studies included in these reviews, we found that the average probability of incorporating productivity loss in an economic evaluation was 10.2%. Among the economic evaluations (n=478) that explicitly considered productivity loss, most (n=455) considered losses from paid work, while only a few studies (n=23) considered unpaid work losses. Recognising the existing methodological challenges and the specific context of China, we proposed a practical research agenda and a disease list for progress on this topic, including the development of the disease list comprehensively consisting of health conditions where the productivity loss should be incorporated into economic evaluations.ConclusionAn increasing number of guidelines recommend the inclusion of productivity loss in the base case or additional analyses of economic evaluation. We optimistically expect that more Chinese researchers notice the importance of incorporating productivity loss in economic evaluations and anticipate guidelines that may be suitable for Chinese practitioners and decision-makers that facilitate the advancement of research on productivity loss measurement and valuation.

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Two-year cost effectiveness between two gradual tapering strategies in rheumatoid arthritis: cost-utility analysis of the TARA trial

Cited by 13 publications

References 22 publications

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update

Comparing cost-utility of DMARDs in autoantibody-negative rheumatoid arthritis patients

Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide for research agenda in China

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