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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Tran-Duy, A, Ghiti Moghadam, M, Oude Voshaar, MAH, Vonkeman, HE, Boonen, A, Philip, C, McColl, G, ten Klooster, PM, Zijlstra, T, Lems, WF, Riyazi, N, Griep, EN, Hazes, M, Landewe, R, Bernelot Moens, HJ, van Riel, PLCM, van de Laar, MAFJ & Jansen, TL 2018, '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', Arthritis & rheumatology, vol. 70, no. 10, pp. 1557-1564. https://doi.org/10.1002/art.40546

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

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.

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DO - 10.1002/art.40546

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