Mapi Values, 133 Portland Street, Boston, MA 02114, USA.
Pharmacoeconomics. 2010;28(4):323-44. doi: 10.2165/11314690-000000000-00000.
To evaluate the cost effectiveness of etoricoxib (90 mg/day) relative to celecoxib (200 or 400 mg/day), and the non-selective NSAIDs naproxen (1000 mg/day) and diclofenac (150 mg/day) in the initial treatment of ankylosing spondylitis (AS) from the UK NHS perspective. A Bayesian cost-effectiveness model was developed to estimate the costs and benefits associated with initiating AS treatment with etoricoxib, celecoxib, diclofenac or naproxen. Efficacy, safety and medical resource and cost data were obtained from the literature. The obtained efficacy estimates were synthesized with a mixed treatment comparison meta-analysis. Treatment benefit and degree of disease activity, as reflected with Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, were related to QALYs and AS-specific costs (related to BASDAI). Other cost outcomes related to drug acquisition, and gastrointestinal and cardiovascular safety. Uncertainty in the source data was translated into uncertainty in cost-effectiveness estimates and therefore decision uncertainty. Costs and outcomes were discounted at 3.5% per annum. There was a >98% probability that treatment with etoricoxib results in greater QALYs than the other interventions. Over a 30-year time horizon, starting AS treatment with etoricoxib was associated with about 0.4 more QALYs than the other interventions. At 2 years there was a 77% probability that etoricoxib had the lowest cost. This increased to >99% at 30 years. Etoricoxib is expected to save 13 620 UK pounds (year 2007 values) relative to celecoxib (200/400 mg), 9957 UK pounds relative to diclofenac and 9863 UK pounds relative to naproxen. For a willingness-to-pay ceiling ratio of 20 000 UK pounds per QALY, there was a >97% probability that etoricoxib was the most cost-effective treatment. Additional analysis with different assumptions, including celecoxib 200 mg, and ignoring cost-offsets associated with improvements in disease activity, supported these findings. This economic evaluation suggests that, from the UK NHS perspective, etoricoxib is the most cost-effective initial NSAID treatment for AS patients.
从英国国家医疗服务体系（NHS）的角度出发，评估依托考昔（90mg/天）相对于塞来昔布（200 或 400mg/天）、非选择性 NSAIDs 萘普生（1000mg/天）和双氯芬酸（150mg/天）在强直性脊柱炎（AS）初始治疗中的成本效益。通过建立贝叶斯成本效益模型来估计使用依托考昔、塞来昔布、双氯芬酸或萘普生开始治疗 AS 的成本和效益。从文献中获得了疗效、安全性和医疗资源以及成本数据。通过混合治疗比较荟萃分析综合了获得的疗效估计值。治疗效益和疾病活动程度（反映在 Bath 强直性脊柱炎功能指数（BASFI）和 Bath 强直性脊柱炎疾病活动指数（BASDAI）评分中）与 QALYs 和 AS 特异性成本（与 BASDAI 相关）相关。其他与药物获取相关的成本结果，以及胃肠道和心血管安全性。将原始数据中的不确定性转化为成本效益估计的不确定性，从而产生决策不确定性。成本和结果按每年 3.5%贴现。使用依托考昔治疗的可能性大于 98%，可获得更高的 QALYs，而其他干预措施则更低。在 30 年的时间范围内，使用依托考昔开始 AS 治疗与其他干预措施相比，预计会多获得约 0.4 个 QALYs。在 2 年内，依托考昔具有最低成本的可能性为 77%。在 30 年内，这一比例增加到>99%。与塞来昔布（200/400mg）相比，依托考昔预计可节省 13620 英镑（2007 年的价值），与双氯芬酸相比，可节省 9957 英镑，与萘普生相比，可节省 9863 英镑。对于愿意支付的上限比率为每 QALY 20000 英镑，依托考昔具有成本效益的可能性大于 97%。对不同假设（包括塞来昔布 200mg）的附加分析，以及忽略与疾病活动改善相关的成本抵消，支持了这些发现。这项经济评估表明，从英国 NHS 的角度来看，依托考昔是 AS 患者初始 NSAID 治疗的最具成本效益的药物。
