title: Cost-effectiveness analysis of rituximab treatment in patients in Germany with rheumatoid arthritis after etanercept-failure.
abstract: OBJECTIVE
  The present health economic analysis investigated the cost-effectiveness-ratios of either (1) rituximab or (2) an alternative TNF-alpha-inhibiting agent as second line biological treatment in patients with active rheumatoid arthritis (RA) and an inadequate response to etanercept therapy.
  
  
  METHODS
  Incremental cost per quality-adjusted life-year (QALY) gained by rituximab treatment of RA is compared to TNF-inhibitor change (standard sequence) in a Markov-model (perspective: health care payer, full life-time approach). Direct cost components taken into account were treatment costs (medication-, administration- and monitoring costs) and resource utilisation (outpatient costs, inpatient costs). Indirect costs were estimated separately by the assessment of impaired work capacity due to RA (2008 Euro currency, discount rate 3.5%). Utility measures for the different treatment options were obtained from the ACR-response rates of published pivotal clinical trials.
  
  
  RESULTS
  Direct costs amount to euro 178,373 (standard sequence) and euro 192,295 (rituximab sequence), respectively, rendering incremental direct costs of euro 13,922. Incremental utilities yield 0.57 QALYs and the incremental cost-effectiveness-ratio (ICER) of rituximab compared to the standard sequence amounts to euro 24,517. Inclusion of indirect costs leads to less incremental costs and a lower ICER of euro 15,565/QALY. Thus, ICERs stay beneath the accepted threshold of euro 50,000/QALY.
  
  
  CONCLUSIONS
  Rituximab appears to be a cost-effective treatment alternative compared to the switch between TNF-inhibitors as second line biological treatment in patients with active RA having failed etanercept.
authors.affiliation: Division of Clinical Immunology and Rheumatology, Working Group for Health Economics and Clinical Epidemiology, Hannover Medical School, Carl-Neuberg-Strasse 1, OE 6830, 30625, Hannover, Germany. merkesdal.sonja@mh-hannover.de
authors.forename: Sonja
authors.initials: S
authors.lastname: Merkesdal
authors.forename: Timm
authors.initials: T
authors.lastname: Kirchhoff
authors.forename: Diane
authors.initials: D
authors.lastname: Wolka
authors.forename: Gunter
authors.initials: G
authors.lastname: Ladinek
authors.forename: Adrian
authors.initials: A
authors.lastname: Kielhorn
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubbert-Roth
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D000068800:Etanercept; D005260:Female; D005858:Germany; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D011336:Probability; D019057:Quality-Adjusted Life Years; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D000069283:Rituximab; D011795:Surveys and Questionnaires; D017211:Treatment Failure
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000069283:Rituximab; D000068800:Etanercept