Yu Andrew P, Johnson Scott, Wang Si-Tien, Atanasov Pavel, Tang Jackson, Wu Eric, Chao Jingdong, Mulani Parvez M
Analysis Group, Inc., Boston, Massachusetts 02199, USA.
Pharmacoeconomics. 2009;27(7):609-21. doi: 10.2165/11312710-000000000-00000.
To determine and compare the cost utilities of the tumour necrosis factor (TNF) antagonists adalimumab and infliximab as maintenance therapies for patients in the US with moderately to severely active Crohn's disease.
Maintenance regimens of adalimumab (40 mg every other week) and infliximab (5 mg/kg) were compared using primary data from the CHARM and published data from the ACCENT I clinical trials. Differences in study samples were minimized by matching and weighting baseline characteristics (Crohn's Disease Activity Index score, age and sex) between the patient groups using the primary clinical trial data. Utilization data were estimated from trial data. Unit costs of TNF antagonists (year 2007 values), hospitalizations (year 2006 values), and other medical costs (year 2006 values) were derived from a systematic literature search. Standard gamble-calculated primary data were used to derive health-utility estimates. Data were analysed in a cost-utility framework from a private payer perspective over a 56-week time horizon. Univariate and probabilistic sensitivity analyses were used to explore uncertainty related to the base-case cost-utility analysis. Given the time horizon, costs and effects were not discounted.
Adalimumab- and infliximab-treated patients were in remission for 47.2% and 37.1% of the 56-week period, respectively. Hospital admissions were 34-40% lower for adalimumab than for infliximab, based on the model and observed data, respectively. Patients treated with adalimumab accrued greater expected QALYs (0.014; 95% CI 0.000, 0.022) and lower costs (-$US4852; 95% CI -6758, 491) in the first year of therapy than patients treated with infliximab. Compared with infliximab maintenance therapy, adalimumab had lower drug and administration costs, less drug waste, and lower hospitalization rates. Univariate and multivariate probabilistic sensitivity analyses suggested that these results were robust.
This analysis suggests that adalimumab maintenance therapy is a dominant strategy versus infliximab maintenance therapy for patients with moderate to severe Crohn's disease. Adalimumab appeared more effective and less costly than infliximab.
确定并比较肿瘤坏死因子（TNF）拮抗剂阿达木单抗和英夫利昔单抗作为美国中度至重度活动性克罗恩病患者维持治疗的成本效用。
使用来自CHARM的原始数据和ACCOUNT I临床试验的已发表数据，比较阿达木单抗（每两周40毫克）和英夫利昔单抗（5毫克/千克）的维持治疗方案。通过使用主要临床试验数据对患者组之间的基线特征（克罗恩病活动指数评分、年龄和性别）进行匹配和加权，将研究样本中的差异最小化。利用试验数据估算使用数据。TNF拮抗剂的单位成本（2007年数值）、住院费用（2006年数值）和其他医疗费用（2006年数值）来自系统的文献检索。使用标准博弈计算的原始数据得出健康效用估计值。从私人支付者的角度，在56周的时间范围内，在成本效用框架内对数据进行分析。单因素和概率敏感性分析用于探索与基础案例成本效用分析相关的不确定性。考虑到时间范围，成本和效果未进行贴现。
在56周的时间里，接受阿达木单抗和英夫利昔单抗治疗的患者分别有47.2%和37.1%处于缓解期。根据模型和观察数据，接受阿达木单抗治疗的患者住院率分别比接受英夫利昔单抗治疗的患者低34%至40%。在治疗的第一年，接受阿达木单抗治疗的患者比接受英夫利昔单抗治疗的患者获得更高的预期质量调整生命年（0.014；95%可信区间0.000，0.022）和更低成本（-4852美元；95%可信区间-6758，491）。与英夫利昔单抗维持治疗相比，阿达木单抗的药物和给药成本更低，药物浪费更少，住院率更低。单因素和多因素概率敏感性分析表明这些结果是可靠的。
该分析表明，对于中度至重度克罗恩病患者，阿达木单抗维持治疗是优于英夫利昔单抗维持治疗的主要策略。阿达木单抗似乎比英夫利昔单抗更有效且成本更低。
