Shi Zhi-Chao, Fei Hong-Ping, Wang Zhi-Liang
Department of Clinical Pharmacy, Lishui People's Hospital, Lishui.
Department of Business Administration, Business School, East China University of Science and Technology, Shanghai, China.
Medicine (Baltimore). 2020 Jan;99(3):e16635. doi: 10.1097/MD.0000000000016635.
This study aimed to explore the cost-effectiveness of etanercept plus methotrexate (ETN+MTX) compared to triple disease-modifying anti-rheumatic drugs (DMARDs) in treating Chinese rheumatoid arthritis (RA) patients.
The 134 Chinese RA patients who were about to initiate ETN+MTX or triple DMARDs therapy based on treat-to-target strategy were consecutively recruited and categorized into ETN+MTX group (N = 49) or triple DMARDs group (N = 85). Treatment efficacy was assessed at month 3 (M3)/M6/M9/M12 after initiation of treatment. Also, 1-year treatment cost was evaluated, and cost-effectiveness analysis and sensitivity analysis were conducted.
RA patients in ETN+MTX group exhibited similar disease activity and quality of life at each time point while elevated 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) change (M0-M12) and low disease activity rate compared with triple DMARDs group. For 1-year treatment cost, ETN+MTX required increased drug cost, decreased other medical cost, and finally elevated total cost compared with triple DMARDs. Meanwhile, compared to triple DMARDs, ETN+MTX produced an additional quality-adjusted life year (QALY) of 0.015, resulting in an incremental cost-effectiveness ratio (ICER) of ¥2,939,506.7 per QALY that was 53.1 folds of gross domestic product (GDP) per capita in China. More interestingly, sensitivity analysis revealed that the ETN price had to be reduced at least by 71.3% before ETN+MTX became cost-effectiveness compared to triple DMARDs.
ETN+MTX is less cost-effective in treating Chinese RA patients compared with triple DMARDs.
本研究旨在探讨与三联改善病情抗风湿药（DMARDs）相比，依那西普联合甲氨蝶呤（ETN+MTX）治疗中国类风湿关节炎（RA）患者的成本效益。
连续招募134例即将根据达标治疗策略开始ETN+MTX或三联DMARDs治疗的中国RA患者，并分为ETN+MTX组（N = 49）或三联DMARDs组（N = 85）。在治疗开始后的第3个月（M3）/第6个月/第9个月/第12个月评估治疗效果。此外，评估1年治疗成本，并进行成本效益分析和敏感性分析。
与三联DMARDs组相比，ETN+MTX组的RA患者在每个时间点的疾病活动度和生活质量相似，但基于红细胞沉降率的28关节疾病活动评分（DAS28-ESR）变化（M0-M12）升高，疾病低活动率较低。对于1年治疗成本，与三联DMARDs相比，ETN+MTX需要增加药物成本，降低其他医疗成本，最终总成本升高。同时，与三联DMARDs相比，ETN+MTX产生了额外的0.015个质量调整生命年（QALY），导致增量成本效益比（ICER）为每QALY 2,939,506.7元，是中国人均国内生产总值（GDP）的53.1倍。更有趣的是，敏感性分析显示，与三联DMARDs相比，在ETN+MTX具有成本效益之前，依那西普价格必须至少降低71.3%。
与三联DMARDs相比，ETN+MTX治疗中国RA患者的成本效益较低。
