Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, WA 98195-7630, USA.
J Med Econ. 2013;16(3):391-6. doi: 10.3111/13696998.2013.763812. Epub 2013 Jan 18.
BACKGROUND/OBJECTIVE: Tumor necrosis factor-alpha (anti-TNF) blocking agents are effective for the treatment of rheumatoid arthritis (RA), with mean response rates of 60-70%. Patients with incomplete response to initial anti-TNF treatment often are switched to other biologic treatments with some success. However, little is known about whether or not switching to anti-TNF or other non-TNF biologic treatments is cost-effective. This study sought to review the economic evidence of sequencing various biologic treatments in RA.
A systematic review was conducted of published and unpublished literature (January 2000 to October 2012) on the cost-effectiveness of sequencing biologic treatments in RA after failure of an initial biologic treatment. It included modeling and other economic studies that assessed cost-effectiveness of one or more sequences of biologics. Studies were excluded that evaluated non-biologic sequencing.
This review of the available evidence suggests that there is limited evidentiary support favoring the cost-effectiveness of switching from one anti-TNF agent to another within the anti-TNF category of biologics. This is due, in large part, to the limited clinical evidence base supporting the incremental efficacy of second- and third-line anti-TNF treatments and to variation on how and when to assess non-response to the first-line biologic. When compared to anti-TNF agents, biologic treatments with a different mechanism of action are more cost-effective as second-line agents.
Not all sequences and patterns of switching, either within or outside of therapeutic class, have been evaluated for clinical benefit and cost-effectiveness, limiting the interpretation of these findings.
Switching from one anti-TNF agent to another after first-line treatment failure may not be a cost-effective treatment strategy. However, when non-TNF biologics are included in the sequence they are likely to be more cost-effective than anti-TNF specific cycling sequences.
背景/目的：肿瘤坏死因子-α（抗 TNF）阻断剂对类风湿关节炎（RA）的治疗有效，平均缓解率为 60-70%。初始抗 TNF 治疗反应不完全的患者常改用其他生物制剂治疗，取得一定疗效。然而，对于是否改用抗 TNF 或其他非 TNF 生物制剂治疗更具成本效益，知之甚少。本研究旨在回顾 RA 中各种生物制剂序贯治疗的经济学证据。
系统检索了 2000 年 1 月至 2012 年 10 月发表和未发表的关于初始生物治疗失败后 RA 中生物制剂序贯治疗的成本效益的文献（抗 TNF 类生物制剂内从一种抗 TNF 药物转换到另一种药物的成本效益证据有限，这在很大程度上是由于支持二线和三线抗 TNF 治疗增量疗效的临床证据基础有限，以及如何以及何时评估对一线生物制剂的无反应存在差异。与抗 TNF 药物相比，具有不同作用机制的生物制剂作为二线药物更具成本效益。
尚未评估治疗类别内或之外的所有转换序列和模式的临床获益和成本效益，限制了这些发现的解释。
一线治疗失败后从一种抗 TNF 药物转换到另一种药物可能不是一种具有成本效益的治疗策略。然而，当非 TNF 生物制剂包含在序列中时，它们可能比抗 TNF 特异性循环序列更具成本效益。
