Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain

摘要: Certolizumab pegol, a PEGylated tumour necrosis factor (TNF)-inhibitor, improves the clinical signs and symptoms of rheumatoid arthritis (RA) when used in combination with methotrexate or as monotherapy. This study evaluatedthe cost-utility certolizumab pegol versusTNF-inhibitors plus treatment moderate-to-severe RA Spain. A Markov cohort health state transition model was developed to evaluate (costs quality-adjusted life years [QALYs]) versus other TNF-inhibitors licensed Spain 2009. Efficacy measured using American College Rheumatology (ACR) responses at 6 months, based on adjusted indirect comparisons from published trials. Utilities were derived EQ-5D data Clinical history resource use came literature. Unit costs taken Spanish databases (cost year 2009). Base case analyses conducted payer perspective, lifetime horizon, 3.5 % annual discounting rates for outcomes, 3 % inflation rate 2009 onwards. One-way sensitivity conducted. The average etanercept, adalimumab (every 2 weeks weekly) infliximab (3 mg/kg 5 mg/kg) €140,971, €141,197, €139,148, €164,741, €136,961 €152,561, respectively. QALYs gained 6.578, 6.462, 6.430 (for both doses), 6.430, 6.318 At €30,000/QALY willingness-to-pay threshold, dominated weekly, 5 mg/kg, cost-effective every 3 mg/kg (all methotrexate), estimated ICERs €12,346/QALY €15,414/QALY, monotherapy more adalimumab, less expensive similar gains etanercept (6.416 vs 6.492). Univariate analysis showed be sensitive changes time ACR response point, baseline Heath Assessment Questionnaire (HAQ) score, HAQ-disability index deterioration after discontinuing treatment. shows that is compared recommended RA.