Kobelt G, Lindgren P, Geborek P
European Health Economics, Mulhouse, France.
Scand J Rheumatol. 2009 Nov-Dec;38(6):409-18. doi: 10.3109/03009740902865464.
To design an economic model describing the costs and outcomes for patients treated with tumour necrosis factor alpha (TNFalpha) inhibitors for rheumatoid arthritis (RA) in current clinical practice in Sweden, to be used as a tool to estimate cost-effectiveness of the next generation of treatments.
The model was constructed as a discrete event simulation (DES) model analysed at patient level. It contains treatment and outcome data for 1903 patients followed in the RA registry for biological drugs in southern Sweden between 1999 and 2007 [the Southern Swedish Arthritis Treatment Group (SSATG) Register]. Resource consumption was based on a survey of 1027 patients in the same region. Costs and quality-adjusted life years (QALYs) are presented for 10(5) years, for patients with the mean characteristics at treatment start in SSATG [Health Assessment Questionnaire (HAQ) score 1.33, disease duration 12.1 years, age 55 years], but also for patients with more or less severe disease. Cost and outcomes (QALYs) are discounted with 3%.
The 10-year costs in the base case amount to USD 336,000 (SD USD 64,000) or EUR 223 000, with a total of 4.4 QALYs. Over 5 years, the costs amount to USD 208,000 or EUR 138,000 and QALYs to 2.5. The results were most sensitive to HAQ level at treatment start, but also to underlying disease progression, age, and disease duration. Starting treatment at a lower HAQ level (0.85) reduces costs by 10% and increase QALYs by 20%.
This analysis is based on the longest available follow-up for patients treated with TNFalpha inhibitors and provides an opportunity to explore treatment strategies when new therapies become available using actual clinical practice data.
设计一种经济模型，描述在瑞典当前临床实践中接受肿瘤坏死因子α（TNFα）抑制剂治疗类风湿关节炎（RA）患者的成本和结局，用作估计下一代治疗成本效益的工具。
该模型构建为在患者层面分析的离散事件模拟（DES）模型。它包含1999年至2007年在瑞典南部生物药物RA登记处随访的1903例患者的治疗和结局数据[瑞典南部关节炎治疗组（SSATG）登记处]。资源消耗基于对同一地区1027例患者的调查。给出了SSATG中治疗开始时具有平均特征的患者[健康评估问卷（HAQ）评分1.33、病程12.1年、年龄55岁]10⁵年的成本和质量调整生命年（QALY），也给出了病情或多或少严重的患者的成本和QALY。成本和结局（QALY）按3%进行贴现。
基础病例的10年成本为336,000美元（标准差64,000美元）或223,000欧元，共有4.4个QALY。5年期间，成本为208,000美元或138,000欧元，QALY为2.5。结果对治疗开始时的HAQ水平最敏感，但也对基础疾病进展、年龄和病程敏感。在较低的HAQ水平（0.85）开始治疗可使成本降低10%，并使QALY增加20%。
该分析基于接受TNFα抑制剂治疗患者的最长可用随访，并提供了一个利用实际临床实践数据探索新疗法可用时治疗策略的机会。
