Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Ann Rheum Dis. 2016 Nov;75(11):1939-1944. doi: 10.1136/annrheumdis-2015-208317. Epub 2016 Jan 13.
A disease activity-guided dose optimisation strategy of adalimumab or etanercept (TNFi (tumour necrosis factor inhibitors)) has shown to be non-inferior in maintaining disease control in patients with rheumatoid arthritis (RA) compared with usual care. However, the cost-effectiveness of this strategy is still unknown.
This is a preplanned cost-effectiveness analysis of the Dose REduction Strategy of Subcutaneous TNF inhibitors (DRESS) study, a randomised controlled, open-label, non-inferiority trial performed in two Dutch rheumatology outpatient clinics. Patients with low disease activity using TNF inhibitors were included. Total healthcare costs were measured and quality adjusted life years (QALY) were based on EQ5D utility scores. Decremental cost-effectiveness analyses were performed using bootstrap analyses; incremental net monetary benefit (iNMB) was used to express cost-effectiveness.
180 patients were included, and 121 were allocated to the dose optimisation strategy and 59 to control. The dose optimisation strategy resulted in a mean cost saving of -€12 280 (95 percentile -€10 502; -€14 104) per patient per 18 months. There is an 84% chance that the dose optimisation strategy results in a QALY loss with a mean QALY loss of -0.02 (-0.07 to 0.02). The decremental cost-effectiveness ratio (DCER) was €390 493 (€5 085 184; dominant) of savings per QALY lost. The mean iNMB was €10 467 (€6553-€14 037). Sensitivity analyses using 30% and 50% lower prices for TNFi remained cost-effective.
Disease activity-guided dose optimisation of TNFi results in considerable cost savings while no relevant loss of quality of life was observed. When the minimal QALY loss is compensated with the upper limit of what society is willing to pay or accept in the Netherlands, the net savings are still high.
NTR3216; Post-results.
与常规治疗相比，针对阿达木单抗或依那西普（肿瘤坏死因子抑制剂，TNFi）的疾病活动指导剂量优化策略在维持类风湿关节炎（RA）患者的疾病控制方面显示出非劣效性。然而，该策略的成本效益仍不清楚。
这是一项针对皮下 TNFi 剂量降低策略（DRESS）研究的预设成本效益分析，该研究是在荷兰两家风湿病门诊进行的一项随机对照、开放标签、非劣效性试验。纳入疾病活动度低的 TNFi 治疗患者。测量总医疗保健成本，并基于 EQ5D 效用评分计算质量调整生命年（QALY）。采用自举分析进行增量成本效益分析；增量净货币收益（iNMB）用于表示成本效益。
共纳入 180 例患者，121 例患者被分配至剂量优化策略组，59 例患者被分配至对照组。与对照组相比，剂量优化策略组的每位患者在 18 个月内的平均成本节省了-€12280（95%CI：-€10502；-€14104）。剂量优化策略导致 QALY 损失的概率为 84%，平均 QALY 损失为-0.02（-0.07 至 0.02）。增量成本效益比（DCER）为每 QALY 损失节省€390493（€5085184；占主导地位）。平均 iNMB 为€10467（€6553-€14037）。使用 TNFi 价格降低 30%和 50%的敏感性分析仍然具有成本效益。
TNFi 的疾病活动指导剂量优化可带来显著的成本节约，同时观察到生活质量无明显损失。当最小 QALY 损失得到荷兰社会愿意支付或接受的上限补偿时，净节省仍然很高。
NTR3216；Post-results。
