Merkesdal Sonja, Ruof Jörg, Mittendorf Thomas, Zeidler Henning
Hannover Medical School, Division of Rheumatology, Carl-Neuberg-Str. 1, 30623 Hannover, Germany.
Expert Opin Pharmacother. 2004 Sep;5(9):1881-6. doi: 10.1517/14656566.5.9.1881.
The current literature covering cost-effectiveness and cost-utility analyses of biological treatments in patients with rheumatoid arthritis (RA) are reviewed in order to discuss options and limitations for future application of these highly priced drugs in routine clinical practice. The cost-effectiveness and cost-utility ratios of the studies analysed are converted into the corresponding Euros of the publication year. Etanercept treatment achieved a cost-effectiveness ratio of 44,300 Euros (2002)/ACR 20 (20% response according to American College of Rheumatology criteria) and 43,100 Euros (2002)/ACR 70WR (ACR 70 weighted response) compared with sulfasalazine and methotrexate, respectively, in methotrexate-naive RA. In methotrexate-resistant RA, the combination of etanercept and methotrexate is compared to a combination therapy of methotrexate, sulfasalazine and hydroxychloroquine revealing costs of 46,100 Euros (2000)/ACR 20, and 37,700 Euros/ACR 70WR. The cost-utility ratios for infliximab treatment range from 16,000 Euros to almost 166,000/QALY (quality adjusted life-year) gained, the studies investigating etanercept treatment show a ratio of approximately 25,000 Euros and 120,000/QALY gained. No substantial differences of cost-utilities of infliximab and etanercept were found. The administration of these drugs as third-line therapy is regarded cost-effective compared to other well-accepted therapies with comparable cost-utility ratios of < 50,000 Euros/QALY gained. Still, data on economic outcomes of RA trials are sparse and further cost-effectiveness and cost-utility evaluations are needed.
本文回顾了目前有关类风湿性关节炎（RA）患者生物治疗的成本效益和成本效用分析的文献，以探讨这些高价药物在常规临床实践中未来应用的选择和局限性。将所分析研究的成本效益和成本效用比率换算为出版年份对应的欧元。在未使用过甲氨蝶呤的RA患者中，与柳氮磺胺吡啶和甲氨蝶呤相比，依那西普治疗达到的成本效益比率分别为44,300欧元（2002年）/美国风湿病学会（ACR）20（根据美国风湿病学会标准的20%反应）和43,100欧元（2002年）/ACR 70WR（ACR 70加权反应）。在对甲氨蝶呤耐药的RA患者中，将依那西普与甲氨蝶呤联合治疗与甲氨蝶呤、柳氮磺胺吡啶和羟氯喹联合治疗进行比较，结果显示成本为46,100欧元（2000年）/ACR 20，以及37,700欧元/ACR 70WR。英夫利昔单抗治疗的成本效用比率范围为16,000欧元至近166,000欧元/获得的质量调整生命年（QALY），研究依那西普治疗的研究显示该比率约为25,000欧元和120,000欧元/获得的QALY。未发现英夫利昔单抗和依那西普的成本效用有实质性差异。与其他成本效用比率<50,000欧元/获得的QALY且被广泛接受的疗法相比，将这些药物作为三线治疗被认为具有成本效益。然而，RA试验的经济结果数据仍然稀少，需要进一步进行成本效益和成本效用评估。
