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Abstract
Objectives: To study: (I) the impact on cost-utility analyses of applying different national EuroQol 5-Dimensions (EQ-5D) preference sets; (II and III) whether, in methotrexate-refractory, early rheumatoid arthritis (RA), the addition of infliximab results in superior health-related quality of life (HRQoL) and may be considered cost-effective, as compared to adding sulfasalazine and hydroxychloroquine; (IV) how costs relate to disability (measured by the health-assessment questionnaire, HAQ), disease activity (28-joint disease activity score, DAS28) and HRQoL (EQ-5D) in RA.
Methods: In the observational SSATG register, one-year quality-adjusted life-year (QALY) accumulation of two interventions was compared according to the UK, US, or Danish EQ-5D preference sets. Two-year QALY accumulation and incremental cost-effectiveness were compared between the treament arms of the SWEFOT trial, randomising methotrexate-refractory, early RA patients to addition of infliximab or sulfasalazine and hydroxychloroquine. Linking SSATG data to register-derived costs of anti-rheumatic drugs, patient care, and work loss, the associations of HAQ, DAS28, and EQ-5D scores to costs were compared by correlation and regression analyses.
Results: Applying the UK, rather than the US or Danish preference sets, resulted in a 50% higher incremental QALY estimate. In the SWEFOT trial, no significant between-group differences were seen regarding QALY accumulation or work loss costs, while drug and healthcare costs were higher in the infliximab arm, resulting in very high incremental cost-effectiveness ratios for the infliximab strategy. Regardless of analysis method, societal RA costs were more closely related to HAQ than DAS28 or EQ-5D scores.
Conclusions: Results of cost-utility analyses may vary depending on the national EQ-5D preference set used. In the SWEFOT trial, similar HRQoL effects were observed in both treatment arms, and the infliximab strategy was not cost-effective over two years. HAQ disability was a better marker of RA costs than DAS28 disease activity or EQ-5D HRQoL.
Methods: In the observational SSATG register, one-year quality-adjusted life-year (QALY) accumulation of two interventions was compared according to the UK, US, or Danish EQ-5D preference sets. Two-year QALY accumulation and incremental cost-effectiveness were compared between the treament arms of the SWEFOT trial, randomising methotrexate-refractory, early RA patients to addition of infliximab or sulfasalazine and hydroxychloroquine. Linking SSATG data to register-derived costs of anti-rheumatic drugs, patient care, and work loss, the associations of HAQ, DAS28, and EQ-5D scores to costs were compared by correlation and regression analyses.
Results: Applying the UK, rather than the US or Danish preference sets, resulted in a 50% higher incremental QALY estimate. In the SWEFOT trial, no significant between-group differences were seen regarding QALY accumulation or work loss costs, while drug and healthcare costs were higher in the infliximab arm, resulting in very high incremental cost-effectiveness ratios for the infliximab strategy. Regardless of analysis method, societal RA costs were more closely related to HAQ than DAS28 or EQ-5D scores.
Conclusions: Results of cost-utility analyses may vary depending on the national EQ-5D preference set used. In the SWEFOT trial, similar HRQoL effects were observed in both treatment arms, and the infliximab strategy was not cost-effective over two years. HAQ disability was a better marker of RA costs than DAS28 disease activity or EQ-5D HRQoL.
| Original language | English |
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| Qualification | Doctor |
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| Award date | 2014 Dec 5 |
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| ISBN (Print) | 978-91-7619-064-7 |
| Publication status | Published - 2014 |
Bibliographical note
Defence detailsDate: 2014-12-05
Time: 13:00
Place: Föreläsningssalen, Reumatologiska Kliniken, SUS Lund. Kioskgatan 3, 22185 Lund
External reviewer(s)
Name: Boonen, Annelies
Title: Professor
Affiliation: Division of Rheumatology, Department of Internal Medicine, The Academic Hospital of Maastricht. Maastricht, the Netherlands
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Subject classification (UKÄ)
- Rheumatology and Autoimmunity
Free keywords
- Cost-utility analysis
- Cost-of-illness
- Quality of life
- EuroQol 5-Dimensions
- Antirheumatic agents
- TNF inhibition
- Outcome assessment
- Disease activity
- Disability
- Health economics
- Rheumatoid arthritis
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Dive into the research topics of 'Health economics and its measures in rheumatoid arthritis'. Together they form a unique fingerprint.Research output
- 2 Article
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Addition of infliximab compared with addition of sulfasalazine and hydroxychloroquine to methotrexate in early rheumatoid arthritis: 2-year quality-of-life results of the randomised, controlled, SWEFOT trial.
Karlsson, J., Neovius, M., Nilsson, J.-Å., Petersson, I., Bratt, J., van Vollenhoven, R. F., Ernestam, S. & Geborek, P., 2013, In: Annals of the Rheumatic Diseases. 72, 12, p. 1927-1933Research output: Contribution to journal › Article › peer-review
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National EQ-5D tariffs and quality-adjusted life-year estimation: comparison of UK, US and Danish utilities in south Swedish rheumatoid arthritis patients.
Karlsson, J., Nilsson, J.-Å., Neovius, M., Kristensen, L. E., Gülfe, A., Saxne, T. & Geborek, P., 2011, In: Annals of the Rheumatic Diseases. 70, p. 2163-2166Research output: Contribution to journal › Article › peer-review