Fragoulakis Vasilis, Vitsou Elli, Hernandez Ana Cristina, Maniadakis Nikolaos
National School of Public Health, Athens, Greece.
Pfizer Hellas, Athens, Greece.
Clinicoecon Outcomes Res. 2015 Jan 16;7:85-93. doi: 10.2147/CEOR.S75323. eCollection 2015.
We aimed to estimate the total mean annual treatment cost of different therapy options for patients with moderate-to-severe rheumatoid arthritis (RA) in Greece.
A cost-minimization approach was adopted. An economic model was developed to estimate the direct costs of the three widely used treatments within a 1-year time horizon, from a health care payer perspective, either for new or for existing patients. Data on resource use, dose escalation, and frequency of therapy were based on a nationwide field survey of rheumatologists. Other analyses were also undertaken based on evidence from the literature. Total cost comprised the cost of drugs, administration, and hospital day care visits. Unit cost data were obtained from the price bulletin and the government gazettes issued by the Ministry of Health. Due to the short time horizon of the study, the cost was not discounted.
The mean annual total cost per new (or per existing) responder patient on etanercept was estimated at €9,845 (€9,840), and the total cost on etanercept/methotrexate (MTX) was estimated at €9,857 (€9,852). Therapy with etanercept had lower annual cost relative to adalimumab and infliximab. On an annual basis, it was estimated that the difference between etanercept monotherapy and adalimumab monotherapy was €544 (€1,323). Similarly, the difference between etanercept/MTX and infliximab/MTX was €1,871 (€1,490) and €543 (€1,323), respectively, relative to adalimumab/MTX. Results remained constant under other scenario analyses undertaken.
In the real-life practice setting in Greece, where dose intensity and frequency differences occur, etanercept alone or in combination with MTX, if prescribed as per label, represents the option with lower annual cost per patient when compared with adalimumab or infliximab in patients with RA. These results hold true as long as the assumptions and data used in the analysis remain stable and may alter if any of the underlying parameters, such as drug price, change.
我们旨在估算希腊中重度类风湿性关节炎（RA）患者不同治疗方案的年均总治疗成本。
采用成本最小化方法。从医疗保健支付方的角度出发，开发了一个经济模型，以估算在1年时间范围内三种广泛使用的治疗方法对新患者或现有患者的直接成本。资源使用、剂量递增和治疗频率的数据基于对风湿病学家的全国性实地调查。还根据文献证据进行了其他分析。总成本包括药物、给药和医院日间护理就诊的成本。单位成本数据来自卫生部发布的价格公告和政府公报。由于研究时间范围较短，成本未进行贴现。
接受依那西普治疗的新（或现有）有反应患者的年均总成本估计为9845欧元（9840欧元），依那西普/甲氨蝶呤（MTX）的总成本估计为9857欧元（9852欧元）。与阿达木单抗和英夫利昔单抗相比，依那西普治疗的年度成本较低。据估计，每年依那西普单药治疗与阿达木单抗单药治疗之间的差异为544欧元（1323欧元）。同样，相对于阿达木单抗/MTX，依那西普/MTX与英夫利昔单抗/MTX之间的差异分别为1871欧元（1490欧元）和543欧元（1323欧元）。在进行的其他情景分析下，结果保持不变。
在希腊的实际临床实践中，存在剂量强度和频率差异，与RA患者使用阿达木单抗或英夫利昔单抗相比，单独使用依那西普或与MTX联合使用（如果按标签规定开具），代表了每位患者年度成本较低的选择。只要分析中使用的假设和数据保持稳定，这些结果就成立，如果任何基础参数（如药品价格）发生变化，结果可能会改变。
