Borse Rebekah H, Brown Chloe, Muszbek Noemi, Chaudhary Mohammad Ashraf, Kachroo Sumesh
Merck Research Laboratories (MRL), Merck & Co., Inc., Kenilworth, NJ, USA.
MSD Ltd, Hoddesdon, UK.
Rheumatol Ther. 2017 Dec;4(2):427-443. doi: 10.1007/s40744-017-0083-1. Epub 2017 Sep 27.
Golimumab is a tumor necrosis factor-α (TNF-α) inhibitor for treatment of patients with severe, active ankylosing spondylitis. This study evaluated the cost-effectiveness of golimumab compared with conventional care and other TNF-α inhibitors in treatment of AS from the UK National Health Service perspective.
A long-term Markov model (with initial decision tree) was developed to simulate the progression of a hypothetical cohort of patients with active AS over a lifetime. The effectiveness outcome was quality-adjusted life-years (QALYs). Utilities were estimated by mapping Bath Ankylosing Spondylitis Functional Index scores, and the primary response measure was ≥50% improvement on the Bath Ankylosing Spondylitis Disease Activity Index at 12 weeks. Direct, medication, and AS management costs were included. Costs and outcomes were discounted at 3.5%.
All TNF-α inhibitors were comparable to each other and superior to conventional care. The incremental cost-effectiveness ratios (ICERs) for TNF-α inhibitors were £19,070-42,532 per QALY gained compared with conventional care. Analyses of the ICERs for each TNF-α inhibitor compared with conventional care demonstrated that golimumab was the most cost-effective treatment, and that adalimumab and etanercept were dominated by golimumab. Sensitivity analyses confirmed the robustness of these analyses.
Golimumab may be considered a cost-effective treatment alternative for patients with active AS. With comparable costs and efficacy among TNF-α inhibitors, the choice of TNF-α inhibitor to treat AS is likely to be driven by patient and physician choice.
Merck & Co., Inc.
戈利木单抗是一种肿瘤坏死因子-α（TNF-α）抑制剂，用于治疗重度活动性强直性脊柱炎患者。本研究从英国国家医疗服务体系的角度评估了戈利木单抗与传统治疗及其他TNF-α抑制剂相比在强直性脊柱炎治疗中的成本效益。
建立了一个长期马尔可夫模型（初始为决策树），以模拟一组假设的活动性强直性脊柱炎患者一生的病情进展。有效性结局为质量调整生命年（QALY）。通过将巴斯强直性脊柱炎功能指数评分进行映射来估算效用值，主要反应指标为12周时巴斯强直性脊柱炎疾病活动指数改善≥50%。纳入了直接成本、药物成本和强直性脊柱炎管理成本。成本和结局按3.5%进行贴现。
所有TNF-α抑制剂相互之间具有可比性，且均优于传统治疗。与传统治疗相比，TNF-α抑制剂每获得一个QALY的增量成本效益比（ICER）为19,070 - 42,532英镑。对每种TNF-α抑制剂与传统治疗的ICER分析表明，戈利木单抗是最具成本效益的治疗方法，阿达木单抗和依那西普被戈利木单抗所主导。敏感性分析证实了这些分析的稳健性。
对于活动性强直性脊柱炎患者，戈利木单抗可被视为一种具有成本效益的治疗选择。由于TNF-α抑制剂之间成本和疗效相当，治疗强直性脊柱炎时TNF-α抑制剂的选择可能由患者和医生的选择驱动。
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