Barra Lillian, Pope Janet E, Payne Michael
Department of Medicine, University of Western Ontario, London, Ontario, Canada.
J Rheumatol. 2009 Jul;36(7):1421-8. doi: 10.3899/jrheum.081122. Epub 2009 Jun 1.
To determine the effectiveness and cost-effectiveness of anti-tumor necrosis factor (anti-TNF) medications in a real-world environment for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) using the Health Assessment Questionnaire (HAQ).
We created a database of patients with RA, PsA, or AS treated with anti-TNF agents (etanercept, infliximab, or adalimumab) at a large outpatient rheumatology clinic. Patient characteristics, baseline HAQ prior to treatment, subsequent yearly HAQ, and reasons for termination were collected. The cost based on percentage of patients achieving >or= 0.2 improvement in HAQ (minimal clinically important difference, MCID) was calculated using the 2008 direct cost (Cdn) of the medication.
Data were available on 297 patients (206 with RA, 57 PsA, 34 AS). The mean age was 55 years, with 12 years of disease, and the mean baseline HAQ (standard error, SE) was 1.37 (0.04). The changes in HAQ (SE) at Years 1, 2, and 3 were -0.31 (0.04), -0.24 (0.06), and -0.27 (0.07) for annual cost to achieve MCID of $41,636, $42,077, and $42,147, respectively. The number needed to treat (NNT) was 1.94 (RA), 1.88 (PsA), and 2.30 (AS). There were no statistical differences between the diseases studied.
We obtained data on the effectiveness and cost-effectiveness of anti-TNF drugs using the HAQ score, which is known to be an excellent predictor of work disability, morbidity, and mortality. HAQ scores decreased with treatment and were sustained throughout the 3-5 years of followup. The NNT of approximately 2 seems favorable and was similar between diseases.
使用健康评估问卷（HAQ）确定在现实环境中抗肿瘤坏死因子（抗TNF）药物治疗类风湿关节炎（RA）、银屑病关节炎（PsA）和强直性脊柱炎（AS）的有效性和成本效益。
我们创建了一个在大型门诊风湿病诊所接受抗TNF药物（依那西普、英夫利昔单抗或阿达木单抗）治疗的RA、PsA或AS患者数据库。收集患者特征、治疗前的基线HAQ、随后每年的HAQ以及终止治疗的原因。使用2008年药物的直接成本（加元）计算基于HAQ改善≥0.2（最小临床重要差异，MCID）的患者百分比的成本。
有297例患者的数据（206例RA、57例PsA、34例AS）。平均年龄为55岁，病程12年，平均基线HAQ（标准误，SE）为1.37（0.04）。第1年、第2年和第3年HAQ（SE）的变化分别为-0.31（0.04）、-0.24（0.06）和-0.27（0.07），实现MCID的年度成本分别为41,636加元、42,077加元、42,147加元。治疗所需人数（NNT）为1.94（RA）、1.88（PsA）和2.30（AS）。所研究的疾病之间无统计学差异。
我们使用HAQ评分获得了抗TNF药物的有效性和成本效益数据，已知HAQ评分是工作残疾、发病率和死亡率的优秀预测指标。HAQ评分随治疗降低，并在3至5年的随访中持续保持。约为2的NNT似乎较为理想，且各疾病之间相似。
