Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects

C.L.M. Krieckaert, S.C. Nair, M.T. Nurmohamed, C.J.J. van Dongen, W.F. Lems, F.P.J.G. Lafeber, J.W.J. Bijlsma, Hendrik Koffijberg, G. Wolbink, P.M.J. Welsing

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Abstract

Objective: To evaluate the cost-effectiveness of personalised treatment for rheumatoid arthritis (RA) using clinical response and serum adalimumab levels.

Methods: A personalised treatment algorithm defined, based on clinical (European League Against Rheumatism) response and drug levels at 6 months, whether adalimumab treatment should be continued in a specific dose or discontinued and/or switched to a next biological. Outcomes were simulated using a patient level Markov model, with 3 months cycles, based on a cohort of 272 adalimumab-treated patients with RA for 3 years and data of patients from the Utrecht Rheumatoid Arthritis Cohort. Costs, clinical effectiveness and quality adjusted life years (QALYs) were compared with outcomes as observed in usual care and incremental cost-effectiveness ratios were calculated. Analyses were performed probabilistically.

Results: Clinical effectiveness was higher for the cohort simulated to receive personalised care compared with usual care; the average difference in QALYs was 3.84 (95 percentile range −8.39 to 16.20). Costs were saved on drugs: €2 314 354. Testing costs amounted to €10 872. Mean total savings were €2 561 648 (95 percentile range −3 252 529 to −1 898 087), resulting in an incremental cost-effectiveness ratio of €666 500 or €646 266 saved per QALY gained from a societal or healthcare perspective, respectively. In 72% of simulations personalised care saved costs and resulted in more QALYs, in 28% it was cost saving with lower QALYs. Scenario analyses showed cost saving along with QALYs gain or limited loss.

Conclusions: Tailoring biological treatment to individual patients with RA starting adalimumab using drug levels and short-term outcome is cost-effective. Results underscore the potential merit of personalised biological treatment in RA.
Original languageEnglish
Pages (from-to)361-368
JournalAnnals of the rheumatic diseases
Volume74
Issue number2
DOIs
Publication statusPublished - 2015

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Quality-Adjusted Life Years
Rheumatoid Arthritis
Costs and Cost Analysis
Cost-Benefit Analysis
Serum
Pharmaceutical Preparations
Cost effectiveness
Costs
Therapeutics
Adalimumab
Delivery of Health Care
Testing

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Krieckaert, C. L. M., Nair, S. C., Nurmohamed, M. T., van Dongen, C. J. J., Lems, W. F., Lafeber, F. P. J. G., ... Welsing, P. M. J. (2015). Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects. Annals of the rheumatic diseases, 74(2), 361-368. https://doi.org/10.1136/annrheumdis-2013-204101
Krieckaert, C.L.M. ; Nair, S.C. ; Nurmohamed, M.T. ; van Dongen, C.J.J. ; Lems, W.F. ; Lafeber, F.P.J.G. ; Bijlsma, J.W.J. ; Koffijberg, Hendrik ; Wolbink, G. ; Welsing, P.M.J. / Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects. In: Annals of the rheumatic diseases. 2015 ; Vol. 74, No. 2. pp. 361-368.
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abstract = "Objective: To evaluate the cost-effectiveness of personalised treatment for rheumatoid arthritis (RA) using clinical response and serum adalimumab levels. Methods: A personalised treatment algorithm defined, based on clinical (European League Against Rheumatism) response and drug levels at 6 months, whether adalimumab treatment should be continued in a specific dose or discontinued and/or switched to a next biological. Outcomes were simulated using a patient level Markov model, with 3 months cycles, based on a cohort of 272 adalimumab-treated patients with RA for 3 years and data of patients from the Utrecht Rheumatoid Arthritis Cohort. Costs, clinical effectiveness and quality adjusted life years (QALYs) were compared with outcomes as observed in usual care and incremental cost-effectiveness ratios were calculated. Analyses were performed probabilistically.Results: Clinical effectiveness was higher for the cohort simulated to receive personalised care compared with usual care; the average difference in QALYs was 3.84 (95 percentile range −8.39 to 16.20). Costs were saved on drugs: €2 314 354. Testing costs amounted to €10 872. Mean total savings were €2 561 648 (95 percentile range −3 252 529 to −1 898 087), resulting in an incremental cost-effectiveness ratio of €666 500 or €646 266 saved per QALY gained from a societal or healthcare perspective, respectively. In 72{\%} of simulations personalised care saved costs and resulted in more QALYs, in 28{\%} it was cost saving with lower QALYs. Scenario analyses showed cost saving along with QALYs gain or limited loss.Conclusions: Tailoring biological treatment to individual patients with RA starting adalimumab using drug levels and short-term outcome is cost-effective. Results underscore the potential merit of personalised biological treatment in RA.",
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Krieckaert, CLM, Nair, SC, Nurmohamed, MT, van Dongen, CJJ, Lems, WF, Lafeber, FPJG, Bijlsma, JWJ, Koffijberg, H, Wolbink, G & Welsing, PMJ 2015, 'Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects' Annals of the rheumatic diseases, vol. 74, no. 2, pp. 361-368. https://doi.org/10.1136/annrheumdis-2013-204101

Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects. / Krieckaert, C.L.M.; Nair, S.C.; Nurmohamed, M.T.; van Dongen, C.J.J.; Lems, W.F.; Lafeber, F.P.J.G.; Bijlsma, J.W.J.; Koffijberg, Hendrik; Wolbink, G.; Welsing, P.M.J.

In: Annals of the rheumatic diseases, Vol. 74, No. 2, 2015, p. 361-368.

Research output: Contribution to journalArticleAcademic

TY - JOUR

T1 - Personalised treatment using serum drug levels of adalimumab in patients with rheumatoid arthritis: an evaluation of costs and effects

AU - Krieckaert, C.L.M.

AU - Nair, S.C.

AU - Nurmohamed, M.T.

AU - van Dongen, C.J.J.

AU - Lems, W.F.

AU - Lafeber, F.P.J.G.

AU - Bijlsma, J.W.J.

AU - Koffijberg, Hendrik

AU - Wolbink, G.

AU - Welsing, P.M.J.

PY - 2015

Y1 - 2015

N2 - Objective: To evaluate the cost-effectiveness of personalised treatment for rheumatoid arthritis (RA) using clinical response and serum adalimumab levels. Methods: A personalised treatment algorithm defined, based on clinical (European League Against Rheumatism) response and drug levels at 6 months, whether adalimumab treatment should be continued in a specific dose or discontinued and/or switched to a next biological. Outcomes were simulated using a patient level Markov model, with 3 months cycles, based on a cohort of 272 adalimumab-treated patients with RA for 3 years and data of patients from the Utrecht Rheumatoid Arthritis Cohort. Costs, clinical effectiveness and quality adjusted life years (QALYs) were compared with outcomes as observed in usual care and incremental cost-effectiveness ratios were calculated. Analyses were performed probabilistically.Results: Clinical effectiveness was higher for the cohort simulated to receive personalised care compared with usual care; the average difference in QALYs was 3.84 (95 percentile range −8.39 to 16.20). Costs were saved on drugs: €2 314 354. Testing costs amounted to €10 872. Mean total savings were €2 561 648 (95 percentile range −3 252 529 to −1 898 087), resulting in an incremental cost-effectiveness ratio of €666 500 or €646 266 saved per QALY gained from a societal or healthcare perspective, respectively. In 72% of simulations personalised care saved costs and resulted in more QALYs, in 28% it was cost saving with lower QALYs. Scenario analyses showed cost saving along with QALYs gain or limited loss.Conclusions: Tailoring biological treatment to individual patients with RA starting adalimumab using drug levels and short-term outcome is cost-effective. Results underscore the potential merit of personalised biological treatment in RA.

AB - Objective: To evaluate the cost-effectiveness of personalised treatment for rheumatoid arthritis (RA) using clinical response and serum adalimumab levels. Methods: A personalised treatment algorithm defined, based on clinical (European League Against Rheumatism) response and drug levels at 6 months, whether adalimumab treatment should be continued in a specific dose or discontinued and/or switched to a next biological. Outcomes were simulated using a patient level Markov model, with 3 months cycles, based on a cohort of 272 adalimumab-treated patients with RA for 3 years and data of patients from the Utrecht Rheumatoid Arthritis Cohort. Costs, clinical effectiveness and quality adjusted life years (QALYs) were compared with outcomes as observed in usual care and incremental cost-effectiveness ratios were calculated. Analyses were performed probabilistically.Results: Clinical effectiveness was higher for the cohort simulated to receive personalised care compared with usual care; the average difference in QALYs was 3.84 (95 percentile range −8.39 to 16.20). Costs were saved on drugs: €2 314 354. Testing costs amounted to €10 872. Mean total savings were €2 561 648 (95 percentile range −3 252 529 to −1 898 087), resulting in an incremental cost-effectiveness ratio of €666 500 or €646 266 saved per QALY gained from a societal or healthcare perspective, respectively. In 72% of simulations personalised care saved costs and resulted in more QALYs, in 28% it was cost saving with lower QALYs. Scenario analyses showed cost saving along with QALYs gain or limited loss.Conclusions: Tailoring biological treatment to individual patients with RA starting adalimumab using drug levels and short-term outcome is cost-effective. Results underscore the potential merit of personalised biological treatment in RA.

U2 - 10.1136/annrheumdis-2013-204101

DO - 10.1136/annrheumdis-2013-204101

M3 - Article

VL - 74

SP - 361

EP - 368

JO - Annals of the rheumatic diseases

JF - Annals of the rheumatic diseases

SN - 0003-4967

IS - 2

ER -