Sany Jacques, Cohen Jean-David, Combescure Christophe, Bozonnat Marie-Cécile, Roch-Bras Françoise, Lafon Georges, Daurès Jean-Pierre
CHU Lapeyronie, Service d'Immuno-Rhumatologie, 191, avenue du Doyen Gaston Giraud, 34093 Montpellier cedex 5, France.
Rheumatology (Oxford). 2009 Oct;48(10):1236-41. doi: 10.1093/rheumatology/kep198. Epub 2009 Jul 20.
To perform, in real conditions of prescription, the medico-economic evaluation of infliximab in severe RA.
A cost-effectiveness analysis of the annual costs was done with a comparison between the previous and the following year under infliximab. The effectiveness, determined from the HAQ, was expressed in clinically significant units and in quality-adjusted life years (QALYs). The incremental net benefit (INB), defined as willingness to pay (lambda), was used to express the results.
A cohort of 635 patients was formed. Before the use of infliximab, after 1 and 2 years, the mean annual cost per patient for the care of RA was 9832, 27,723 and 46,704 euro, respectively. Among the direct costs, infliximab accounts for 21,182 euro for the first year. The distribution of the different costs was similar after 2 years. By using the INB, the difference before and after 1 year under infliximab is significant, on average by 1.86 (S.E.M. = 0.76) when the effectiveness is expressed in clinically significant units. For severe HAQ, lambda is 9841 euro (18,593 for all HAQ). When it is expressed in QALYs, also for severe HAQ, lambda > 100,000 euro. This can be explained by a short follow-up although severe complication of RA appears later.
An evaluation of the more long-term costs is required in order to determine whether there are any full economic benefits with this treatment.
在实际处方条件下，对英夫利昔单抗治疗重度类风湿关节炎（RA）进行药物经济学评估。
对英夫利昔单抗治疗前后一年的年度成本进行成本效益分析。从健康评估问卷（HAQ）确定的有效性，以具有临床意义的单位和质量调整生命年（QALY）表示。用定义为支付意愿（λ）的增量净效益（INB）来表达结果。
形成了一个635名患者的队列。在使用英夫利昔单抗之前、1年和2年后，每位患者治疗RA的年均成本分别为9832欧元、27723欧元和46704欧元。在直接成本中，英夫利昔单抗第一年占21182欧元。2年后不同成本的分布相似。使用INB时，英夫利昔单抗治疗1年后前后的差异显著，当有效性以具有临床意义的单位表示时，平均差异为1.86（标准误=0.76）。对于严重的HAQ，λ为9841欧元（所有HAQ为18593欧元）。当以QALY表示时，同样对于严重的HAQ，λ>100000欧元。这可以通过随访时间短来解释，尽管RA的严重并发症出现较晚。
需要对更长期的成本进行评估，以确定这种治疗是否有任何完全的经济效益。
