OP0094 Cost-Effectiveness of Biologic Versus Conventional Combination Treatment in Early Rheumatoid Arthritis: 2-Year Results of the Randomised Controlled Swefot Trial. (23rd January 2014)

• Record Type: Journal Article
• Authors: Eriksson, J.; Karlsson, J. A.; Bratt, J.; Petersson, I. F.; van Vollenhoven, R. F.; Ernestam, S.; Geborek, P.; Neovius, M.
• Is Part Of: Annals of the rheumatic diseases. Volume 72:Supplement 3(2013)
• Page Start: A82
• Page End: A82
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2013-eular.299
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Adding infliximab (IFX) or sulfasalazine+hydroxychloroquine (SSZ+HCQ) to methotrexate (MTX) in patients with active, early rheumatoid arthritis (RA), resulted in superior radiographic outcome in the IFX group, [1 ] while disease-activity, utility and work loss improved in both arms, without detectable between-group differences at 21 months[1 -3 ]. Objectives: To evaluate the cost-effectiveness of biologic vs. conventional combination treatment in early RA-patients responding insufficiently to MTX. Methods: This multicenter, randomised, controlled, open-label trial enrolled RA-patients (symptoms<1y) in Sweden between 2002 and 2005. After 3-4 months of MTX monotherapy, patients with a remaining DAS28>3.2 were randomised to addition of IFX or SSZ+HCQ. The incremental cost-effectiveness ratio (ICER=€/quality-adjusted life-year [QALY]) was assessed during 21 months from randomisation. Costs of RA-related medications, non-primary healthcare utilisation and work loss were retrieved from nationwide registers, while EuroQol 5-Dimensions utility was collected quarterly. Undiscounted analyses including all patients were performed from the societal (human capital method) and healthcare perspectives. Confidence intervals were estimated by non-parametric bootstrapping. Results: Of 487 patients initially enrolled, 128 and 130 were randomised to biologic and conventional treatment, respectively. The biologic group had higher drug and healthcare costs (€27, 487 vs. 10, 364; adjusted mean difference 16, 956 [95%CI 14, 647;19, 162]), while no difference was seen in productivity losses (€33, 804 vs. 29, 220; 3, 961 [-3, 986;11, 850]), resulting in higher societal cost, as compared to the conventional treatment arm (€61, 291 vs. 39, 584; 20, 916 [12, 800;28, 660]). Mean accumulated QALYs were 1.10 in the biologic and 1.12 in the conventional treatment group (adjusted mean difference 0.01 [95%CI -0.07;0.08]). The resulting ICER, comparing the biologic to the conventional treatment option, was €2, 404, 197/QALY from the societal (Figure ), and €1, 948, 919/QALY from the healthcare perspective. Image/graph: Conclusions: In early MTX-refractory RA, the addition of IFX, as compared to addition of SSZ+HCQ, was not cost-effective over 21 months at willingness to pay levels generally considered acceptable. References: van Vollenhoven RF, et al. Lancet 2012;379:1712-1720. Karlsson JA, et al. Ann Rheum Dis 2012. Nov 29 [Epub ahead of print]. Eriksson JK, et al. ACR 2011; Abstract no: 459. Disclosure of Interest: None Declared