TY - JOUR
T1 - Two-year cost-effectiveness of different COBRA-like intensive remission induction schemes in early rheumatoid arthritis
T2 - a piggyback study on the pragmatic randomised controlled CareRA trial
AU - Pazmino, Sofia
AU - Boonen, Annelies
AU - Stouten, Veerle
AU - De Cock, Diederik
AU - Joly, Johan
AU - Van der Elst, Kristien
AU - Westhovens, Rene
AU - Verschueren, Patrick
N1 - Publisher Copyright:
© 2020 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/5
Y1 - 2020/5
N2 - Objectives To evaluate the cost-effectiveness of treat-to-target strategies among recently diagnosed patients with rheumatoid arthritis (RA) using methotrexate (MTX) and a step-down glucocorticoid (GC) scheme (COBRA Slim) compared with (1) this combination with either sulphasalazine (COBRA Classic) or leflunomide (COBRA Avant-G arde) in high-risk patients and (2) MTX without GCs (Tight-S tep-Up, TSU) in low-risk patients.Methods The incremental cost-utility was calculated from a healthcare perspective in the intention-to-treat population (n=379) of the 2-year open-label pragmatic randomised controlled Care in early RA trial. Healthcare costs were collected prospectively through electronic trial records. Quality-adjusted life years (QALYs) were estimated using mapping algorithms for EuroQoL-5 Dimension. Multiple imputation was used to handle missing data and bootstrapping to calculate CIs. Robustness was tested with biological disease-modifying antirheumatic drugs at biosimilar prices.Results In the high-risk group, Classic (Delta k(sic)1.464, 95%CI -0.198 to 3.127) and Avant-G arde (Delta k(sic)0.636, 95%CI -0.987 to 2.258) were more expensive compared with Slim and QALYs were slightly worse for Classic (Delta-0.002, 95%CI -0.086 to 0.082) and Avant-Garde (Delta-0.009, 95%CI -0.102 to 0.084). This resulted in the domination of Classic and Avant-G arde by Slim. In the low-risk group, Slim was cheaper (Delta k(sic)-0.617, 95%CI -2.799 to 1.566) and QALYs were higher (Delta 0.141, 95%CI 0.008 to 0.274) compared with TSU, indicating Slim dominated. Results were robust against the price of biosimilars.Conclusions The combination of MTX with a GC bridging scheme is less expensive with comparable health utility than more intensive step-down combination strategies or a conventional step-up approach 2 years after initial treatment.
AB - Objectives To evaluate the cost-effectiveness of treat-to-target strategies among recently diagnosed patients with rheumatoid arthritis (RA) using methotrexate (MTX) and a step-down glucocorticoid (GC) scheme (COBRA Slim) compared with (1) this combination with either sulphasalazine (COBRA Classic) or leflunomide (COBRA Avant-G arde) in high-risk patients and (2) MTX without GCs (Tight-S tep-Up, TSU) in low-risk patients.Methods The incremental cost-utility was calculated from a healthcare perspective in the intention-to-treat population (n=379) of the 2-year open-label pragmatic randomised controlled Care in early RA trial. Healthcare costs were collected prospectively through electronic trial records. Quality-adjusted life years (QALYs) were estimated using mapping algorithms for EuroQoL-5 Dimension. Multiple imputation was used to handle missing data and bootstrapping to calculate CIs. Robustness was tested with biological disease-modifying antirheumatic drugs at biosimilar prices.Results In the high-risk group, Classic (Delta k(sic)1.464, 95%CI -0.198 to 3.127) and Avant-G arde (Delta k(sic)0.636, 95%CI -0.987 to 2.258) were more expensive compared with Slim and QALYs were slightly worse for Classic (Delta-0.002, 95%CI -0.086 to 0.082) and Avant-Garde (Delta-0.009, 95%CI -0.102 to 0.084). This resulted in the domination of Classic and Avant-G arde by Slim. In the low-risk group, Slim was cheaper (Delta k(sic)-0.617, 95%CI -2.799 to 1.566) and QALYs were higher (Delta 0.141, 95%CI 0.008 to 0.274) compared with TSU, indicating Slim dominated. Results were robust against the price of biosimilars.Conclusions The combination of MTX with a GC bridging scheme is less expensive with comparable health utility than more intensive step-down combination strategies or a conventional step-up approach 2 years after initial treatment.
KW - MODIFYING ANTIRHEUMATIC DRUGS
KW - TREATMENT STRATEGIES
KW - MULTIPLE IMPUTATION
KW - CLINICAL-TRIALS
KW - DISEASE
KW - METHOTREXATE
KW - COMBINATION
KW - EQ-5D
KW - QUESTIONNAIRE
KW - UTILITIES
U2 - 10.1136/annrheumdis-2019-216874
DO - 10.1136/annrheumdis-2019-216874
M3 - Article
C2 - 32241795
SN - 0003-4967
VL - 79
SP - 556
EP - 565
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 5
ER -