Health Economics and Outcomes Research, Bristol-Myers Squibb, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA.
J Med Econ. 2010 Mar;13(1):33-41. doi: 10.3111/13696990903508021.
To estimate the incremental cost per quality-adjusted life-years (QALYs) for abatacept and rituximab, in combination with methotrexate, relative to methotrexate alone in patients with active rheumatoid arthritis (RA).
A patient-level simulation model was used to depict the progression of functional disability over the lifetimes of women aged 55-64 years with active RA and inadequate response to a tumor necrosis factor (TNF)-alpha antagonist therapy. Future health-state utilities and medical care costs were based on projected values of the Health Assessment Questionnaire Disability Index (HAQ-DI). Patients were assumed to receive abatacept or rituximab in combination with methotrexate until death or therapy discontinuation due to lack of efficacy or adverse events. HAQ-DI improvement at month 6, after adjustments for control drug (methotrexate) response, was derived from two clinical trials. Costs of medical care and biologic drugs, discounted at 3% annually, were from the perspective of a US third-party payer and expressed in 2007 US dollars.
Relative to methotrexate alone, abatacept/methotrexate and rituximab/methotrexate therapies were estimated to yield an average of 1.25 and 1.10 additional QALYs per patient, at mean incremental costs of $58,989 and $60,380, respectively. The incremental cost-utility ratio relative to methotrexate was $47,191 (95% CI $44,810-49,920) per QALY gained for abatacept/methotrexate and $54,891 (95% CI $52,274-58,073) per QALY gained for rituximab/methotrexate. At an acceptability threshold of $50,000 per QALY, the probability of cost effectiveness was 90% for abatacept and 0.0% for rituximab.
Abatacept was estimated to be more cost effective than rituximab for use in RA from a US third-party payer perspective. However, head-to-head clinical trials and long-term observational data are needed to confirm these findings.
评估阿巴西普和利妥昔单抗联合甲氨蝶呤与单独使用甲氨蝶呤治疗活动性类风湿关节炎（RA）患者的增量成本每质量调整生命年（QALYs）。
采用患者水平模拟模型描述 55-64 岁女性中患有活性 RA 且对肿瘤坏死因子（TNF）-α拮抗剂治疗反应不足的患者在其一生中的功能残疾进展情况。未来的健康状态效用和医疗费用基于健康评估问卷残疾指数（HAQ-DI）的预测值。假设患者接受阿巴西普或利妥昔单抗联合甲氨蝶呤治疗，直至死亡或因疗效不佳或不良反应而停药。在调整对照药物（甲氨蝶呤）反应后，从两项临床试验中得出第 6 个月 HAQ-DI 改善的结果。医疗保健和生物药物的成本，按 3%的年贴现率贴现，来自美国第三方支付者的角度，并以 2007 年美元表示。
与单独使用甲氨蝶呤相比，阿巴西普/甲氨蝶呤和利妥昔单抗/甲氨蝶呤治疗分别估计每位患者平均额外获得 1.25 和 1.10 个 QALYs，增量成本分别为 58989 美元和 60380 美元。与甲氨蝶呤相比，阿巴西普/甲氨蝶呤每获得一个 QALY 的增量成本-效用比为 47191 美元（95%CI 44810-49920），利妥昔单抗/甲氨蝶呤每获得一个 QALY 的增量成本-效用比为 54891 美元（95%CI 52274-58073）。在接受阈值为 50000 美元/QALY 的情况下，阿巴西普的成本效益概率为 90%，而利妥昔单抗的概率为 0.0%。
从美国第三方支付者的角度来看，阿巴西普治疗 RA 的成本效益估计优于利妥昔单抗。然而，需要进行头对头的临床试验和长期观察性数据来证实这些发现。
