Nuijten M J, Engelfriet P, Duijn K, Bruijn G, Wierz D, Koopmanschap M
MEDTAP International, Amsterdam, The Netherlands.
Pharmacoeconomics. 2001;19(10):1051-64. doi: 10.2165/00019053-200119100-00006.
The objective of this study was to compare the total costs associated with the administration of two different tumour necrosis factor (TNF) strategies used in the treatment of rheumatoid arthritis (RA): etanercept, a soluble TNF receptor that can be administered at home by subcutaneous injection, versus infliximab, an antibody that requires an intravenous infusion in a hospital outpatient setting.
The main analytical framework of the study was a cost-cost analysis comparing the total annual costs associated with the administration of etanercept and infliximab in adult RA patients. The perspective of the study was that of the Dutch society. An economic model was constructed to determine the costs of both treatments. The cost evaluation included direct medical costs, direct nonmedical costs and indirect costs. The base-case analysis compared monotherapy with etanercept versus a combination therapy with infliximab and methotrexate. Data for the economic model came from published literature, expert opinion and official price and tariff lists. All costs were in 1999 values.
The analysis was performed for the adult RA population eligible for treatment with etanercept or infliximab in The Netherlands.
The analysis showed that the total annual drug costs per patient do not differ substantially between infliximab and etanercept, with costs of Netherland guilders (NLG)31,526 (12,610 US dollars) and NLG31,334 (12,534 US dollars), respectively. However, the other medical costs (i.e. excluding the costs of the two drugs themselves) are substantially higher for infliximab due to the additional costs associated with administration in an outpatient clinic and the use of methotrexate [NLG 12,621 (5048 US dollars) versus NLG269 (107 US dollars) for etanercept]. The impact of direct nonmedical costs (transportation) and indirect costs were negligible. Overall treatment with infliximab is more expensive than treatment with etanercept with total costs of NLG45 115 (18,046 US dollars) and NLG3I,621 (12,648 US dollars), respectively (42.7% increase).
Based on the assumptions used in the model, we may conclude that the use of etanercept compares favourably with infliximab from a budgetary and health economic perspective: the total costs are substantially lower when the efficacy of etanercept is assumed to be at least equivalent to the efficacy of infliximab.
本研究的目的是比较用于治疗类风湿关节炎（RA）的两种不同肿瘤坏死因子（TNF）治疗策略的相关总成本：依那西普，一种可在家中皮下注射给药的可溶性TNF受体，与英夫利昔单抗，一种需要在医院门诊环境中静脉输注的抗体。
该研究的主要分析框架是成本-成本分析，比较成人RA患者使用依那西普和英夫利昔单抗给药的年度总成本。研究视角为荷兰社会。构建了一个经济模型来确定两种治疗方法的成本。成本评估包括直接医疗成本、直接非医疗成本和间接成本。基础病例分析比较了依那西普单药治疗与英夫利昔单抗和甲氨蝶呤联合治疗。经济模型的数据来自已发表的文献、专家意见以及官方价格和收费清单。所有成本均为1999年的价值。
对荷兰符合使用依那西普或英夫利昔单抗治疗条件的成年RA人群进行了分析。
分析表明，英夫利昔单抗和依那西普每位患者的年度药物总成本差异不大，分别为荷兰盾（NLG）31,526（12,610美元）和NLG31,334（12,534美元）。然而，英夫利昔单抗的其他医疗成本（即不包括两种药物本身的成本）要高得多，这是由于门诊给药和使用甲氨蝶呤产生的额外成本[依那西普为NLG 12,621（5048美元），而英夫利昔单抗为NLG269（107美元）]。直接非医疗成本（交通）和间接成本的影响可忽略不计。英夫利昔单抗总体治疗比依那西普更昂贵，总成本分别为NLG45 115（18,046美元）和NLG3I,621（12,648美元）（增加42.7%）。
基于模型中使用的假设，我们可以得出结论，从预算和卫生经济学角度来看，依那西普的使用优于英夫利昔单抗：假设依那西普的疗效至少与英夫利昔单抗相当，则总成本要低得多。
