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

An Tran-Duy, Marjan Ghiti Moghadam (Corresponding Author), Martijn A.H. Oude Voshaar, Harald E. Vonkeman, Annelies Boonen, Clarke Philip, Geoff McColl, Peter M. ten Klooster, Theo Zijlstra, Willem F. Lems, N Riyazi, Eduard N. Griep, Mieke Hazes, Robert Landewe, Hein J. Bernelot Moens, Piet L.C.M. van Riel, Mart A.F.J. van de Laar, Tim L. Jansen

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Abstract

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.
Original languageEnglish
Pages (from-to)1557-1564
Number of pages8
JournalArthritis & rheumatology
Volume70
Issue number10
Early online date9 May 2018
DOIs
Publication statusPublished - Oct 2018

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Quality-Adjusted Life Years
Cost-Benefit Analysis
Rheumatoid Arthritis
Costs and Cost Analysis
Tumor Necrosis Factor-alpha
Therapeutics
Drug Costs
Health Expenditures
Netherlands
Delivery of Health Care
Pharmaceutical Preparations

Keywords

  • UT-Hybrid-D

Cite this

Tran-Duy, An ; Ghiti Moghadam, Marjan ; 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. / 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. In: Arthritis & rheumatology. 2018 ; Vol. 70, No. 10. pp. 1557-1564.
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abstract = "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.",
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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 journalArticleAcademicpeer-review

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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.

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