University of Texas MD Anderson Cancer Center and Houston School of Public Health, University of Texas Health Science Center at Houston.
University of Texas MD Anderson Cancer Center, Houston.
Arthritis Care Res (Hoboken). 2020 Mar;72(3):343-352. doi: 10.1002/acr.23859.
To systematically review the modeling approaches and quality of economic analyses comparing cycling tumor necrosis factor inhibitors (TNFi) to swapping to a therapy with a different mode of action in patients with rheumatoid arthritis whose initial TNFi failed.
We searched electronic databases, gray literature, and references of included publications until July 2017. Two reviewers independently screened citations. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Data regarding modeling methodology were extracted.
We included 7 articles comprising 19 comparisons. Three studies scored ≥16 of 24 on the CHEERS checklist. Most models used a lifetime horizon, took a payer perspective, employed a 6-month cycle length, and measured treatment efficacy in terms of the American College of Rheumatology improvement criteria. We noted possible sources of bias in terms of transparency and study sponsorship. In the cost-utility comparisons, the median incremental cost-effectiveness ratio was US $70,332 per quality-adjusted life-year for swapping versus cycling strategies. Rituximab was more effective and less expensive than TNFi in 7 of 11 comparisons. Abatacept (intravenous) compared to TNFi was less cost-effective than rituximab. Common influential parameters in sensitivity analyses were the rituximab dosing schedule, assumptions regarding disease progression, and the estimation of utilities.
Differences in the design, key assumptions, and model structure chosen had a major impact on the individual study conclusions. Despite the existence of multiple reporting standards, there continues to be a need for more uniformity in the methodology reported in economic evaluations of cycling versus swapping strategies after TNFi in patients with rheumatoid arthritis.
系统回顾比较肿瘤坏死因子抑制剂（TNFi）循环与转换为作用机制不同的治疗方法治疗初始 TNFi 失败的类风湿关节炎患者的建模方法和经济分析质量。
我们检索了电子数据库、灰色文献和纳入文献的参考文献，直到 2017 年 7 月。两位审查员独立筛选引文。使用统一健康经济评估报告标准（CHEERS）声明评估报告质量。提取有关建模方法的数据。
我们纳入了 7 篇文章，共包含 19 项比较。3 项研究在 CHEERS 清单上的得分≥16 分。大多数模型采用终生时间范围，从支付者角度出发，采用 6 个月的周期长度，并根据美国风湿病学会改善标准衡量治疗效果。我们注意到在透明度和研究赞助方面可能存在偏差的来源。在成本效益比较中，与循环策略相比，转换策略的增量成本效益比的中位数为每质量调整生命年 70332 美元。在 11 项比较中有 7 项比较，利妥昔单抗比 TNFi 更有效且更便宜。在敏感性分析中，常见的影响参数是利妥昔单抗的剂量方案、疾病进展的假设以及效用的估计。
选择的设计、关键假设和模型结构的差异对个别研究结论有重大影响。尽管存在多种报告标准，但在类风湿关节炎患者 TNFi 后循环与转换策略的经济评估中，仍需要在报告方法上更加统一。
