Modelling the cost-effectiveness of etanercept in adults with rheumatoid arthritis in the UK.
OBJECTIVE
This model examines the cost-effectiveness of etanercept monotherapy under British Society for Rheumatology guidelines, i.e. adults previously failing two disease-modifying anti-rheumatic drugs (DMARDs). It compares a DMARD sequence with etanercept third line against the same sequence excluding etanercept.


METHODS
The 6-monthly trend in Health Assessment Questionnaire (HAQ) disability score is simulated for 10 000 patients' lifetimes using clinical trial data and published literature. Switching to the next treatment is triggered by lack of response, loss of efficacy or adverse events. Patient mortality depends on rheumatoid arthritis life-tables and on epidemiological evidence relating reduced risk to HAQ improvement. Regression of HAQ/EuroQol (EQ-5D) utility provides quality-adjusted life years (QALY) gained. Primary analysis includes drug costs, monitoring and hospitalizations.


RESULTS
The central estimate cost per QALY is pound 16 330. Sensitivity analyses ( pound 7800 to pound 42 000) showed long-term HAQ progression (etanercept, DMARDs, non-responders) as most sensitive variables. The inclusion of potential avoided nursing home admissions and indirect costs/lost employment further improves the cost-effectiveness.


CONCLUSIONS
For adults in the UK, the results suggest that etanercept is cost-effective when compared with non-biologic agents. The National Institute for Clinical Excellence has accepted that etanercept is cost-effective and recommended its availability for use in patients who have failed at least two DMARDs. This model was an important component of that decision. The model is further suitable for use for a wide range of other cost-effectiveness questions in rheumatoid arthritis.
Brennan
A
A
Operational Research, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK. A.Brennan@Sheffield.ac.uk
Bansback
N
N
Reynolds
A
A
Conway
P
P
D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D011788:Quality of Life; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D006113:United Kingdom
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept