Triple therapy versus biologic therapy for Active Rheumatoid Arthritis a cost-effectiveness analysis

Nick Bansback, Ciaran Phibbs, Huiying Sun, James R. O'Dell, Mary Brophy, Edward C. Keystone, Sarah Leatherman, Ted R. Mikuls, Aslam H. Anis, William Ayoub, Gilles Boire, Vivian Bykerk, Andrew Chow, Keith Colburn, David Daikh, John Davis, Hani El-Gabalawy, Jennifer Elliott, Joseph Fanciullo, Samardeep Gupta & 25 others Keri Hannagan, Raymond Hausch, Erika Holmberg, Amy Joseph, Salahuddin Kazi, Peter Kent, Gail Kerr, Karen Kolba, Chian K Kwoh, Maren Mahowald, Liam Martin, Thomas Olenginski, Jay Persselin, Mahfooz Peshimam, Lynne Peterson, Pamela Prete, David Pugliese, Virginia Reddy, Andreas Reimold, Jude Rodrigues, H. Ralph Schumacher, J. Carter Thorne, Joanne Valeriano-Marcet, Cynthia Weaver, Ciaran S. Phibbs

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be noninferior to etanercept-methotrexate in patients with active rheumatoid arthritis (RA). Objective: To determine the cost-effectiveness of etanercept-methotrexate versus triple therapy as a first-line strategy. Design: A within-trial analysis based on the 353 participants in the RACAT trial and a lifetime analysis that extrapolated costs and outcomes by using a decision analytic cohort model. Data Sources: The RACAT trial and sources from the literature. Target Population: Patients with active RA despite at least 12 weeks of methotrexate therapy. Time Horizon: 24 weeks and lifetime. Perspective: Societal and Medicare. Intervention: Etanercept-methotrexate first versus triple therapy first. Outcome Measures: Incremental costs, quality-adjusted lifeyears (QALYs), and incremental cost-effectiveness ratios (ICERs). Results of Base-Case Analysis: The within-trial analysis found that etanercept-methotrexate as first-line therapy provided marginally more QALYs but accumulated substantially higher drug costs. Differences in other costs between strategies were negligible. The ICERs for first-line etanercept-methotrexate and triple therapy were $2.7 million per QALY and $0.98 million per QALY over 24 and 48 weeks, respectively. The lifetime analysis suggested that first-line etanercept-methotrexate would result in 0.15 additional lifetime QALY, but this gain would cost an incremental $77 290, leading to an ICER of $521 520 per QALY per patient. Results of Sensitivity Analysis: Considering a long-term perspective, an initial strategy of etanercept-methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions. Limitation: Data on the long-term benefit of triple therapy are uncertain. Conclusion: Initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit. Primary Funding Source: The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.

Original languageEnglish (US)
Pages (from-to)8-16
Number of pages9
JournalAnnals of Internal Medicine
Volume167
Issue number1
DOIs
StatePublished - Jul 4 2017
Externally publishedYes

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Biological Therapy
Cost-Benefit Analysis
Rheumatoid Arthritis
Methotrexate
Costs and Cost Analysis
Therapeutics
Drug Costs
Health Services Needs and Demand
Information Storage and Retrieval
National Institutes of Health (U.S.)
Veterans
Medicare
Etanercept
Biological Products

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Bansback, N., Phibbs, C., Sun, H., O'Dell, J. R., Brophy, M., Keystone, E. C., ... Phibbs, C. S. (2017). Triple therapy versus biologic therapy for Active Rheumatoid Arthritis a cost-effectiveness analysis. Annals of Internal Medicine, 167(1), 8-16. https://doi.org/10.7326/M16-0713

Triple therapy versus biologic therapy for Active Rheumatoid Arthritis a cost-effectiveness analysis. / Bansback, Nick; Phibbs, Ciaran; Sun, Huiying; O'Dell, James R.; Brophy, Mary; Keystone, Edward C.; Leatherman, Sarah; Mikuls, Ted R.; Anis, Aslam H.; Ayoub, William; Boire, Gilles; Bykerk, Vivian; Chow, Andrew; Colburn, Keith; Daikh, David; Davis, John; El-Gabalawy, Hani; Elliott, Jennifer; Fanciullo, Joseph; Gupta, Samardeep; Hannagan, Keri; Hausch, Raymond; Holmberg, Erika; Joseph, Amy; Kazi, Salahuddin; Kent, Peter; Kerr, Gail; Kolba, Karen; Kwoh, Chian K; Mahowald, Maren; Martin, Liam; Olenginski, Thomas; Persselin, Jay; Peshimam, Mahfooz; Peterson, Lynne; Prete, Pamela; Pugliese, David; Reddy, Virginia; Reimold, Andreas; Rodrigues, Jude; Schumacher, H. Ralph; Thorne, J. Carter; Valeriano-Marcet, Joanne; Weaver, Cynthia; Phibbs, Ciaran S.

In: Annals of Internal Medicine, Vol. 167, No. 1, 04.07.2017, p. 8-16.

Research output: Contribution to journalArticle

Bansback, N, Phibbs, C, Sun, H, O'Dell, JR, Brophy, M, Keystone, EC, Leatherman, S, Mikuls, TR, Anis, AH, Ayoub, W, Boire, G, Bykerk, V, Chow, A, Colburn, K, Daikh, D, Davis, J, El-Gabalawy, H, Elliott, J, Fanciullo, J, Gupta, S, Hannagan, K, Hausch, R, Holmberg, E, Joseph, A, Kazi, S, Kent, P, Kerr, G, Kolba, K, Kwoh, CK, Mahowald, M, Martin, L, Olenginski, T, Persselin, J, Peshimam, M, Peterson, L, Prete, P, Pugliese, D, Reddy, V, Reimold, A, Rodrigues, J, Schumacher, HR, Thorne, JC, Valeriano-Marcet, J, Weaver, C & Phibbs, CS 2017, 'Triple therapy versus biologic therapy for Active Rheumatoid Arthritis a cost-effectiveness analysis', Annals of Internal Medicine, vol. 167, no. 1, pp. 8-16. https://doi.org/10.7326/M16-0713
Bansback, Nick ; Phibbs, Ciaran ; Sun, Huiying ; O'Dell, James R. ; Brophy, Mary ; Keystone, Edward C. ; Leatherman, Sarah ; Mikuls, Ted R. ; Anis, Aslam H. ; Ayoub, William ; Boire, Gilles ; Bykerk, Vivian ; Chow, Andrew ; Colburn, Keith ; Daikh, David ; Davis, John ; El-Gabalawy, Hani ; Elliott, Jennifer ; Fanciullo, Joseph ; Gupta, Samardeep ; Hannagan, Keri ; Hausch, Raymond ; Holmberg, Erika ; Joseph, Amy ; Kazi, Salahuddin ; Kent, Peter ; Kerr, Gail ; Kolba, Karen ; Kwoh, Chian K ; Mahowald, Maren ; Martin, Liam ; Olenginski, Thomas ; Persselin, Jay ; Peshimam, Mahfooz ; Peterson, Lynne ; Prete, Pamela ; Pugliese, David ; Reddy, Virginia ; Reimold, Andreas ; Rodrigues, Jude ; Schumacher, H. Ralph ; Thorne, J. Carter ; Valeriano-Marcet, Joanne ; Weaver, Cynthia ; Phibbs, Ciaran S. / Triple therapy versus biologic therapy for Active Rheumatoid Arthritis a cost-effectiveness analysis. In: Annals of Internal Medicine. 2017 ; Vol. 167, No. 1. pp. 8-16.
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T1 - Triple therapy versus biologic therapy for Active Rheumatoid Arthritis a cost-effectiveness analysis

AU - Bansback, Nick

AU - Phibbs, Ciaran

AU - Sun, Huiying

AU - O'Dell, James R.

AU - Brophy, Mary

AU - Keystone, Edward C.

AU - Leatherman, Sarah

AU - Mikuls, Ted R.

AU - Anis, Aslam H.

AU - Ayoub, William

AU - Boire, Gilles

AU - Bykerk, Vivian

AU - Chow, Andrew

AU - Colburn, Keith

AU - Daikh, David

AU - Davis, John

AU - El-Gabalawy, Hani

AU - Elliott, Jennifer

AU - Fanciullo, Joseph

AU - Gupta, Samardeep

AU - Hannagan, Keri

AU - Hausch, Raymond

AU - Holmberg, Erika

AU - Joseph, Amy

AU - Kazi, Salahuddin

AU - Kent, Peter

AU - Kerr, Gail

AU - Kolba, Karen

AU - Kwoh, Chian K

AU - Mahowald, Maren

AU - Martin, Liam

AU - Olenginski, Thomas

AU - Persselin, Jay

AU - Peshimam, Mahfooz

AU - Peterson, Lynne

AU - Prete, Pamela

AU - Pugliese, David

AU - Reddy, Virginia

AU - Reimold, Andreas

AU - Rodrigues, Jude

AU - Schumacher, H. Ralph

AU - Thorne, J. Carter

AU - Valeriano-Marcet, Joanne

AU - Weaver, Cynthia

AU - Phibbs, Ciaran S.

PY - 2017/7/4

Y1 - 2017/7/4

N2 - Background: The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be noninferior to etanercept-methotrexate in patients with active rheumatoid arthritis (RA). Objective: To determine the cost-effectiveness of etanercept-methotrexate versus triple therapy as a first-line strategy. Design: A within-trial analysis based on the 353 participants in the RACAT trial and a lifetime analysis that extrapolated costs and outcomes by using a decision analytic cohort model. Data Sources: The RACAT trial and sources from the literature. Target Population: Patients with active RA despite at least 12 weeks of methotrexate therapy. Time Horizon: 24 weeks and lifetime. Perspective: Societal and Medicare. Intervention: Etanercept-methotrexate first versus triple therapy first. Outcome Measures: Incremental costs, quality-adjusted lifeyears (QALYs), and incremental cost-effectiveness ratios (ICERs). Results of Base-Case Analysis: The within-trial analysis found that etanercept-methotrexate as first-line therapy provided marginally more QALYs but accumulated substantially higher drug costs. Differences in other costs between strategies were negligible. The ICERs for first-line etanercept-methotrexate and triple therapy were $2.7 million per QALY and $0.98 million per QALY over 24 and 48 weeks, respectively. The lifetime analysis suggested that first-line etanercept-methotrexate would result in 0.15 additional lifetime QALY, but this gain would cost an incremental $77 290, leading to an ICER of $521 520 per QALY per patient. Results of Sensitivity Analysis: Considering a long-term perspective, an initial strategy of etanercept-methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions. Limitation: Data on the long-term benefit of triple therapy are uncertain. Conclusion: Initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit. Primary Funding Source: The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.

AB - Background: The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be noninferior to etanercept-methotrexate in patients with active rheumatoid arthritis (RA). Objective: To determine the cost-effectiveness of etanercept-methotrexate versus triple therapy as a first-line strategy. Design: A within-trial analysis based on the 353 participants in the RACAT trial and a lifetime analysis that extrapolated costs and outcomes by using a decision analytic cohort model. Data Sources: The RACAT trial and sources from the literature. Target Population: Patients with active RA despite at least 12 weeks of methotrexate therapy. Time Horizon: 24 weeks and lifetime. Perspective: Societal and Medicare. Intervention: Etanercept-methotrexate first versus triple therapy first. Outcome Measures: Incremental costs, quality-adjusted lifeyears (QALYs), and incremental cost-effectiveness ratios (ICERs). Results of Base-Case Analysis: The within-trial analysis found that etanercept-methotrexate as first-line therapy provided marginally more QALYs but accumulated substantially higher drug costs. Differences in other costs between strategies were negligible. The ICERs for first-line etanercept-methotrexate and triple therapy were $2.7 million per QALY and $0.98 million per QALY over 24 and 48 weeks, respectively. The lifetime analysis suggested that first-line etanercept-methotrexate would result in 0.15 additional lifetime QALY, but this gain would cost an incremental $77 290, leading to an ICER of $521 520 per QALY per patient. Results of Sensitivity Analysis: Considering a long-term perspective, an initial strategy of etanercept-methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions. Limitation: Data on the long-term benefit of triple therapy are uncertain. Conclusion: Initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit. Primary Funding Source: The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.

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