Wong John B, Singh Gurkirpal, Kavanaugh Arthur
Division of Clinical Decision Making, Department of Medicine, Tupper Research Institute, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Am J Med. 2002 Oct 1;113(5):400-8. doi: 10.1016/s0002-9343(02)01243-3.
To estimate the cost-effectiveness of infliximab plus methotrexate for active, refractory rheumatoid arthritis.
We projected the 54-week results from a randomized controlled trial of infliximab into lifetime economic and clinical outcomes using a Markov computer simulation model. Direct and indirect costs, quality of life, and disability estimates were based on trial results; Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) database outcomes; and published data. Results were discounted using the standard 3% rate. Because most well-accepted medical therapies have cost-effectiveness ratios below $50,000 to $100,000 per quality-adjusted life-year (QALY) gained, results below this range were considered to be "cost-effective."
At 3 mg/kg, each infliximab infusion would cost $1393. When compared with methotrexate alone, 54 weeks of infliximab plus methotrexate decreased the likelihood of having advanced disability from 23% to 11% at the end of 54 weeks, which projected to a lifetime marginal cost-effectiveness ratio of $30,500 per discounted QALY gained, considering only direct medical costs. When applying a societal perspective and including indirect or productivity costs, the marginal cost-effectiveness ratio for infliximab was $9100 per discounted QALY gained. The results remained relatively unchanged with variation of model estimates over a broad range of values.
Infliximab plus methotrexate for 54 weeks for rheumatoid arthritis should be cost-effective with its clinical benefit providing good value for the drug cost, especially when including productivity losses. Although infliximab beyond 54 weeks will likely be cost-effective, the economic and clinical benefit remains uncertain and will depend on long-term results of clinical trials.
评估英夫利昔单抗联合甲氨蝶呤治疗活动性难治性类风湿关节炎的成本效益。
我们使用马尔可夫计算机模拟模型，将英夫利昔单抗随机对照试验的54周结果推算为终生经济和临床结局。直接和间接成本、生活质量及残疾评估均基于试验结果、关节炎、风湿病和衰老医学信息系统（ARAMIS）数据库结局以及已发表的数据。结果采用3%的标准贴现率进行贴现。由于大多数被广泛接受的医学疗法每获得一个质量调整生命年（QALY）的成本效益比低于50,000至100,000美元，因此该范围内以下的结果被认为是“具有成本效益的”。
在3mg/kg剂量下，每次英夫利昔单抗输注成本为1393美元。与单用甲氨蝶呤相比，54周的英夫利昔单抗联合甲氨蝶呤治疗使54周结束时出现严重残疾的可能性从23%降至11%，仅考虑直接医疗成本时，推算出每获得一个贴现QALY的终生边际成本效益比为30,500美元。从社会角度考虑并纳入间接或生产力成本时，英夫利昔单抗的边际成本效益比为每获得一个贴现QALY 9100美元。在广泛的数值范围内，模型估计值的变化对结果影响相对较小。
英夫利昔单抗联合甲氨蝶呤治疗类风湿关节炎54周应具有成本效益，其临床益处相对于药物成本具有较高价值，尤其是在考虑生产力损失时。尽管超过54周的英夫利昔单抗治疗可能具有成本效益，但其经济和临床益处仍不确定，将取决于临床试验的长期结果。
