Centre for Health Economics, University of York, Heslington, York, UK.
Rheumatology (Oxford). 2011 Sep;50 Suppl 4:iv39-iv47. doi: 10.1093/rheumatology/ker245.
A probabilistic model was developed to determine the cost-effectiveness of three biologics, etanercept, infliximab and adalimumab, compared with palliative care for the treatment of active and progressive PsA in patients who have an inadequate response to standard treatment (including DMARDs).
A previous model was revised to evaluate the impact of biologics on both skin and joint disease and to include new evidence from the clinical review and evidence synthesis. Initial response to biologics was determined using the PsA response criteria. The impact of biologics on the arthritis component of the disease is then modelled via a change in the HAQ and the impact of the psoriasis component measured using the Psoriasis Area and Severity Index.
For PsA patients with mild to moderate skin disease, the incremental cost-effectiveness ratio (ICER) for etanercept vs palliative care is around £18 000, and the ICER for infliximab vs etanercept is around £44 000 per quality-adjusted life year (QALY). Adalimumab is extendedly dominated. The probability that etanercept is cost effective is 0.436 at a threshold of £20 000 per QALY. Etanercept is also likely to be cost effective for patients with moderate to severe psoriasis or negligible skin involvement.
Further investigation is required to reduce uncertainties around a number of model parameters, in particular the length of time over which biologics are assumed to be effective and the progression of HAQ on and off treatment.
为评估生物制剂（依那西普、英夫利昔单抗和阿达木单抗）对比姑息治疗在标准治疗（包括 DMARDs）失败后对活动期和进展性银屑病关节炎（PsA）患者的有效性和经济性，建立了一个概率模型。
对先前的模型进行修订，以评估生物制剂对皮肤和关节疾病的影响，并纳入临床审查和证据综合的新证据。生物制剂的初始反应采用 PsA 反应标准确定。然后，通过改变健康评估问卷（HAQ）来模拟生物制剂对疾病关节炎部分的影响，通过使用银屑病面积和严重程度指数（PASI）来衡量银屑病部分的影响。
对于皮肤疾病轻度至中度的 PsA 患者，依那西普与姑息治疗相比，增量成本效益比（ICER）约为 18000 英镑，英夫利昔单抗与依那西普相比，ICER 约为每质量调整生命年（QALY）44000 英镑。阿达木单抗则具有扩展优势。在 20000 英镑/QALY 的阈值下，依那西普具有成本效益的概率为 0.436。对于中度至重度银屑病或皮肤受累程度较低的患者，依那西普也可能具有成本效益。
需要进一步研究以降低模型中多个参数的不确定性，特别是生物制剂被认为有效的时间长度以及治疗期间和治疗后 HAQ 的进展。
