title: Cost-effectiveness of real-world infliximab use in patients with rheumatoid arthritis in Sweden.
abstract: OBJECTIVE
  The objective of this study was to estimate the cost-effectiveness of infliximab use in patients with rheumatoid arthritis (RA) in Swedish clinical practice, based on patient-level data from the Stockholm TNF-alpha follow-up registry (STURE).
  
  
  METHODS
  Real-world patient-level data on infliximab use from the STURE registry were implemented in a Markov cohort model, in which health states of functional status were classified according to the Health Assessment Questionnaire Disability Index (HAQ-five categories) and twenty-eight joint count Disease Activity Score (DAS28). The transition probabilities between HAQ and DAS28 states during treatment, as well as discontinuation rates were modeled based on data from the registry for patients using infliximab as their first-line biological treatment. The transition probabilities in the comparator arm, that is, disease progression without biologic treatment, as well as mortality rates, costs, and utilities were based on published literature. The analysis had a societal cost perspective.
  
  
  RESULTS
  Infliximab was associated with an incremental gain in quality-adjusted life-years of 1.02 and an incremental cost of 23,264 euros per patient compared with progression without biologic treatment, producing an incremental cost-effectiveness ratio (ICER) of 22,830 euros (SEK211,136 or US$31,230). Sensitivity analyses of input parameters and model assumptions produced ICERs in the range from 18,000 euros to 47,000 euros.
  
  
  CONCLUSIONS
  Results from base-case and sensitivity analyses fell well below established benchmarks for cost-effectiveness in Sweden. The results, therefore, indicated that infliximab treatment for RA has provided good societal value for money in Swedish clinical practice, compared with a scenario of no biological treatment.
authors.affiliation: i3 Innovus and MMC, LIME, Stockholm, Sweden. ingrid.lekander@i3innovus.com
authors.forename: Ingrid
authors.initials: I
authors.lastname: Lekander
authors.forename: Fredrik
authors.initials: F
authors.lastname: Borgström
authors.forename: Patrick
authors.initials: P
authors.lastname: Svarvar
authors.forename: Tryggve
authors.initials: T
authors.lastname: Ljung
authors.forename: Cheryl
authors.initials: C
authors.lastname: Carli
authors.forename: Ronald F
authors.initials: RF
authors.lastname: van Vollenhoven
mesh_terms: D017677:Age Distribution; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D006801:Humans; D000069285:Infliximab; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012042:Registries / Q000706:statistics & numerical data; D017678:Sex Distribution; D013548:Sweden
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab