ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 2781

Cost-Effectiveness of Adding Etanercept Vs. Sulfasalazine and Hydroxychloroquine to Methotrexate Therapy: A Randomized Noninferiority Trial

Nick Bansback1, Ciaran Phibbs2, Huiying Sun3, James R. O'Dell4, Mary Brophy5, Edward C. Keystone6, Sarah Leatherman7, Ted R. Mikuls4 and Aslam H. Anis3, 1School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, 2Health Economics Resource Center (152), Palo Alto VA Health Care System, Menlo Park, CA, 3St. Paul's Hospital, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada, 4Omaha VA Medical Center and University of Nebraska Medical Center, Omaha, NE, 5VA Boston Heathcare System, Boston, MA, 6Medicine, University of Toronto, Toronto, ON, Canada, 7VA Boston Heatlhcare System, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Economics, randomized trials and rheumatoid arthritis (RA)

  • Tweet
  • Email
  • Print
Session Information

Session Title: ACR Plenary Session III: Discovery 2014

Session Type: Plenary Sessions

Background/Purpose: To estimate the incremental cost-effectiveness of etanercept plus methotrexate versus a triple regimen of disease-modifying anti rheumatic drugs (methotrexate, sulfasalazine, and hydroxychloroquine) over 24 weeks and 48 weeks in patients with active rheumatoid arthritis despite methotrexate therapy (RACAT).

 

Methods: In this double blind, noninferiority trial 353 patients were randomized to etanercept plus methotrexate or a triple regimen. After 24 weeks of treatment patients not achieving a DAS28 improvement of 1.2 were switched in a blinded fashion to the other therapy. Quality Adjusted Life Years (QALYs) were estimated using US societal values from the EQ-5D instrument which was measured every 24 weeks. Costs of drugs, hospitalizations, procedures, tests, visits and lost productivity were prospectively tracked and monetized from a societal perspective in 2014 US dollars. Incremental cost-effectiveness ratios were calculated using standard procedures assuming an intent-to-treat analysis, with missing data analyzed using multiple imputation and uncertainty assessed using bootstrapping.

 

Results: Both strategies showed significant improvements in EQ-5D, with etanercept providing marginally more accumulated QALYs (0.358 vs 0.354 over 24 weeks, and 0.742 vs 0.726 over 48 weeks for etanercept and triple regimen strategies respectively).  The etanercept strategy accumulated substantially higher drug costs even considering the switches between treatements at 24 weeks ($11,286 vs $369 cumulative costs from 0 to 24 weeks, and $19,625 vs $3,721 cumulative costs from 0 to 48 weeks for etanercept and triple regimen respectively).  The differences in other health care and productivity costs across strategies were negligible.  The resultant incremental cost-effectiveness ratios for etanercept vs. triple regimen were $2.7 million/QALY (95%CI 0.87 to ∞) gained over 24 weeks and $0.95 million/QALY (95%CI 0.41 to ∞) over 48 weeks.

 

Conclusion: This economic evaluation based on a prospective tracking of resource use and QALY measurement in a blinded, randomized trial demonstrates that the additional costs associated with using etanercept prior to a triple regimen does not provide good value for money at generally acceptable willingness to pay thresholds. A limitation of the study is its short time frame. However, even when considering the long-term perspective, since the incremental benefits are so small, even under the most optimistic scenarios imaginable, etanercept has only a small probability of being cost-effective compared to triple therapy. Given the opportunity cost associated with all health care spending, adapting a triple regimen prior to etanercept would free up scarce health dollars for use on alternative health care interventions that provide greater health benefits.

 

 

 


Disclosure:

N. Bansback,
None;

C. Phibbs,
None;

H. Sun,
None;

J. R. O’Dell,

Abbvie, Lilly, Antares, Medac,

5;

M. Brophy,
None;

E. C. Keystone,

Abbott Laboratories,

2,

Amgen Canada,

2,

Astrazeneca Pharmaceuticals LP,

2,

Bristo-Myers Squibb,

2,

F. Hoffman La-Roche Inc.,

2,

Janssen Pharmaceutica Product, L.P.,

2,

Eli Lilly and Company,

2,

Novartis Pharmaceutical Corporation,

2,

Pfizer Inc,

2,

Sanofi-Aventis Pharmaceutical,

2,

Abbott Laboratories,

5,

AstraZeneca,

5,

Biotest,

5,

Bristol-Myers Squibb,

5,

F. Hoffman-La Roche Inc.,

5,

Genentech and Biogen IDEC Inc.,

5,

Janssen Pharmaceutica Product, L.P.,

5,

Eli Lilly and Company,

5,

Merck Pharmaceuticals,

5,

Pfizer Inc,

5,

Abbott Laboratories,

8,

AstraZeneca,

8,

Bristol-Myers Squibb,

8,

F. Hoffman La-Roche Inc.,

8,

Janssen Pharmaceutica Product, L.P.,

8,

Pfizer Inc,

8,

UCB,

8,

Amgen,

8;

S. Leatherman,
None;

T. R. Mikuls,

Genentech/Roche,

2;

A. H. Anis,

Pfizer Inc,

2,

Antares, Pfizer, Abbvie,

5.

  • Tweet
  • Email
  • Print

« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-effectiveness-of-adding-etanercept-vs-sulfasalazine-and-hydroxychloroquine-to-methotrexate-therapy-a-randomized-noninferiority-trial/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2023 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences