Borse Rebekah H, Kachroo Sumesh, Brown Chloe, McCann Eilish, Insinga Ralph P
Merck & Co., Inc., Kenilworth, NJ, USA.
Merck Sharp & Dohme, Hoddesdon, UK.
Rheumatol Ther. 2018 Jun;5(1):57-73. doi: 10.1007/s40744-018-0108-4. Epub 2018 Apr 9.
The aim of this study is to assess the cost-effectiveness of golimumab for the treatment of non-radiographic axial spondyloarthritis (nr-axSpA) vs. conventional therapy and other tumor necrosis factor inhibitors from the Scottish payer perspective.
A model comprising a short-term decision tree and a long-term Markov model was developed to compare cost-effectiveness (incremental costs per quality-adjusted life-year [QALY]) for patients in Scotland with nr-axSpA treated by conventional therapy, adalimumab, certolizumab pegol, etanercept, or golimumab for a lifetime period. A network meta-analysis (NMA) was conducted to identify clinical and safety data for treatments and synthesize the available evidence into relative treatment effects between comparators. The probability of patients achieving an Assessment of SpondyloArthritis International Society 20/40% response criteria (ASAS20/ASAS40) or a 50% improvement in Bath Ankylosing Spondylitis Disease Activity Index score (BASDAI50) at week 12 was obtained from the NMA for each of the comparators. Baseline health state utilities were based on the EQ-5D questionnaire collected in the golimumab GO-AHEAD study. The cost of treatment was calculated based on drug acquisition, drug administration, and initiation/monitoring costs.
Golimumab resulted in an increase of 2.06 QALYs and additional cost of £39,770 compared with conventional therapy. Incremental cost per QALY gained was £19,280 for golimumab, which was lower than adalimumab (£19,737), etanercept (£20,089), and higher than certolizumab pegol (£18,710). Golimumab remained cost-effective throughout a range of sensitivity analyses where key assumptions were tested.
From a Scottish perspective, golimumab was a cost-effective treatment for nr-axSpA compared with conventional therapy at a willingness-to-pay threshold of £30,000 per QALY.
Merck & Co., Inc.
本研究旨在从苏格兰医保支付方的角度评估戈利木单抗治疗非放射学中轴型脊柱关节炎（nr-axSpA）相对于传统疗法及其他肿瘤坏死因子抑制剂的成本效益。
构建了一个包含短期决策树和长期马尔可夫模型的模型，以比较苏格兰nr-axSpA患者接受传统疗法、阿达木单抗、聚乙二醇化赛妥珠单抗、依那西普或戈利木单抗终身治疗的成本效益（每质量调整生命年[QALY]的增量成本）。进行了一项网状Meta分析（NMA），以确定各治疗方法的临床和安全性数据，并将现有证据综合为各比较组之间的相对治疗效果。从NMA中获取了各比较组患者在第12周达到脊柱关节炎国际协会评估20/40%缓解标准（ASAS20/ASAS40）或巴斯强直性脊柱炎疾病活动指数评分改善50%（BASDAI50）的概率。基线健康状态效用值基于戈利木单抗GO-AHEAD研究中收集的EQ-5D问卷。治疗成本根据药物采购、药物给药以及启动/监测成本进行计算。
与传统疗法相比，戈利木单抗使QALY增加了2.06，额外成本为39,770英镑。戈利木单抗每获得一个QALY的增量成本为19,280英镑，低于阿达木单抗（19,737英镑）、依那西普（20,089英镑），高于聚乙二醇化赛妥珠单抗（18,710英镑）。在一系列对关键假设进行检验的敏感性分析中，戈利木单抗始终具有成本效益。
从苏格兰的角度来看，在每QALY支付意愿阈值为30,000英镑的情况下，与传统疗法相比，戈利木单抗是一种治疗nr-axSpA具有成本效益的疗法。
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