Abstract
METHODS: Data were collected from a pragmatic, open label trial. Cost-utility analysis was performed using the non-parametric bootstrapping method and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit (NMB) framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost.
RESULTS: 531 patients were randomized to the Stop Group and 186 patients to the Continue Group. Withdrawal of TNFis resulted in more than 60% reduction of the total drug cost, but led to an increase of about 30% in the other healthcare expenditure. Compared to continuation, stopping TNFis resulted in a mean yearly cost saving of €7,133 (95% CI, [€6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI, [0.002, 0.040]). Mean saved cost [95% CI] per QALY lost and per extra flare incurred in the Stop group compared to the Continuation group was €368,269 [€155,132, €1,675,909] and €17,670 [€13,650, €22,721], respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFis is cost-effective was 100%.
CONCLUSION: Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on the willingness-to-pay.
| Original language | English |
|---|---|
| Pages (from-to) | 1557-1564 |
| Number of pages | 8 |
| Journal | Arthritis & rheumatology |
| Volume | 70 |
| Issue number | 10 |
| Early online date | 9 May 2018 |
| DOIs | |
| Publication status | Published - Oct 2018 |
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Keywords
- UT-Hybrid-D
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An economic evaluation of stopping versus continuing TNF-inhibitor treatment in rheumatoid arthritis patients in remission or low disease activity : results from the POET randomized trial. / Tran-Duy, An; Ghiti Moghadam, Marjan (Corresponding Author); Oude Voshaar, Martijn A.H.; Vonkeman, Harald E.; Boonen, Annelies; Philip, Clarke; McColl, Geoff; ten Klooster, Peter M.; Zijlstra, Theo; Lems, Willem F.; Riyazi, N; Griep, Eduard N.; Hazes, Mieke; Landewe, Robert; Bernelot Moens, Hein J.; van Riel, Piet L.C.M.; van de Laar, Mart A.F.J.; Jansen, Tim L.
In: Arthritis & rheumatology, Vol. 70, No. 10, 10.2018, p. 1557-1564.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - An economic evaluation of stopping versus continuing TNF-inhibitor treatment in rheumatoid arthritis patients in remission or low disease activity
T2 - results from the POET randomized trial
AU - Tran-Duy, An
AU - Ghiti Moghadam, Marjan
AU - Oude Voshaar, Martijn A.H.
AU - Vonkeman, Harald E.
AU - Boonen, Annelies
AU - Philip, Clarke
AU - McColl, Geoff
AU - ten Klooster, Peter M.
AU - Zijlstra, Theo
AU - Lems, Willem F.
AU - Riyazi, N
AU - Griep, Eduard N.
AU - Hazes, Mieke
AU - Landewe, Robert
AU - Bernelot Moens, Hein J.
AU - van Riel, Piet L.C.M.
AU - van de Laar, Mart A.F.J.
AU - Jansen, Tim L.
N1 - Wiley deal
PY - 2018/10
Y1 - 2018/10
N2 - OBJECTIVE: To evaluate, from a societal perspective, the incremental cost-effectiveness of withdrawing tumor necrosis factor inhibitors (TNFis) compared to continuation of these drugs within a one-year randomized trial among patients with rheumatoid arthritis (RA) having longstanding stable disease activity or remission.METHODS: Data were collected from a pragmatic, open label trial. Cost-utility analysis was performed using the non-parametric bootstrapping method and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit (NMB) framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost.RESULTS: 531 patients were randomized to the Stop Group and 186 patients to the Continue Group. Withdrawal of TNFis resulted in more than 60% reduction of the total drug cost, but led to an increase of about 30% in the other healthcare expenditure. Compared to continuation, stopping TNFis resulted in a mean yearly cost saving of €7,133 (95% CI, [€6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI, [0.002, 0.040]). Mean saved cost [95% CI] per QALY lost and per extra flare incurred in the Stop group compared to the Continuation group was €368,269 [€155,132, €1,675,909] and €17,670 [€13,650, €22,721], respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFis is cost-effective was 100%.CONCLUSION: Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on the willingness-to-pay.
AB - OBJECTIVE: To evaluate, from a societal perspective, the incremental cost-effectiveness of withdrawing tumor necrosis factor inhibitors (TNFis) compared to continuation of these drugs within a one-year randomized trial among patients with rheumatoid arthritis (RA) having longstanding stable disease activity or remission.METHODS: Data were collected from a pragmatic, open label trial. Cost-utility analysis was performed using the non-parametric bootstrapping method and a cost-effectiveness acceptability curve was constructed using the net-monetary benefit (NMB) framework, where a willingness-to-accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality-adjusted life year (QALY) lost.RESULTS: 531 patients were randomized to the Stop Group and 186 patients to the Continue Group. Withdrawal of TNFis resulted in more than 60% reduction of the total drug cost, but led to an increase of about 30% in the other healthcare expenditure. Compared to continuation, stopping TNFis resulted in a mean yearly cost saving of €7,133 (95% CI, [€6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI, [0.002, 0.040]). Mean saved cost [95% CI] per QALY lost and per extra flare incurred in the Stop group compared to the Continuation group was €368,269 [€155,132, €1,675,909] and €17,670 [€13,650, €22,721], respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFis is cost-effective was 100%.CONCLUSION: Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on the willingness-to-pay.
KW - UT-Hybrid-D
UR - http://www.scopus.com/inward/record.url?scp=85052487906&partnerID=8YFLogxK
U2 - 10.1002/art.40546
DO - 10.1002/art.40546
M3 - Article
VL - 70
SP - 1557
EP - 1564
JO - Arthritis & rheumatology
JF - Arthritis & rheumatology
SN - 2326-5191
IS - 10
ER -