title: Cost-effectiveness of biologic agents for treatment of autoimmune disorders: structured review of the literature.
abstract: OBJECTIVE
  Four new biologic treatments have been approved for several autoimmune disorders. Economic evaluations have been used to model their cost-effectiveness.
  
  
  METHODS
  We conducted a structured literature review in Embase and PubMed to identify all relevant cost-effectiveness models investigating one or more of these 4 drugs in autoimmune disorders.
  
  
  RESULTS
  Fifteen full economic evaluations were identified [13 for rheumatoid arthritis (RA), 2 for Crohn's disease (CD), and 1 for ankylosing spondylitis (AS)]. While several studies found adalimumab, etanercept, and infliximab to be cost-effective (using a threshold around $50,000/quality-adjusted life-year) for treatment of severe RA, not all studies concurred, and there was significant variation in the range of cost-effectiveness ratios reported. Neither study in CD found treatment with infliximab to be cost-effective. Only one study was identified in AS: treatment with infliximab was found to be cost-effective.
  
  
  CONCLUSIONS
  Modeling treatment strategies in chronic relapsing diseases such as RA, CD, and AS presents particular challenges, as reflected in the variation in cost-effectiveness results reported. A reference case for economic evaluations, such as that suggested by the OMERACT (Outcome Measures in Rheumatology) Health Economics Working Group will facilitate comparison and interpretation of results.
authors.affiliation: Health Care Analytics Group, United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. rachael.fleurence@unitedbiosource.com
authors.forename: Rachael
authors.initials: R
authors.lastname: Fleurence
authors.forename: Eldon
authors.initials: E
authors.lastname: Spackman
mesh_terms: D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D019057:Quality-Adjusted Life Years
chemical_list: D007155:Immunologic Factors