Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates
Abstract Background Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | Cost Effectiveness and Resource Allocation |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12962-017-0081-8 |
| _version_ | 1818970715880161280 |
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| author | Stephanie Harvard Daphne Guh Nick Bansback Pascal Richette Alain Saraux Bruno Fautrel Aslam Anis |
| author_facet | Stephanie Harvard Daphne Guh Nick Bansback Pascal Richette Alain Saraux Bruno Fautrel Aslam Anis |
| author_sort | Stephanie Harvard |
| collection | DOAJ |
| description | Abstract Background Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria on anti-TNF cost-effectiveness is unknown. Our objective was to use data from the DESIR cohort, a prospective study of early SpA patients in France, to determine whether the French anti-TNF access criteria are the most cost-effective in that setting relative to other potential restrictions. Methods We used data from the DESIR cohort to create five study populations of patients meeting anti-TNF access criteria from Canada, France, Germany, United Kingdom, and Hong Kong, respectively. For each study population, we calculated the costs and quality-adjusted life years (QALYs) over 1 year of patients treated and not treated with anti-TNF therapy. To control for differences between anti-TNF users and non-users, we used linear regression models to derive adjusted mean costs and QALYs. We calculated incremental cost-effectiveness ratios (ICERs) representing the incremental cost per additional QALY gained by treating with an anti-TNF within each of the five study populations, using bootstrapping to explore the range of uncertainty in costs and QALYs. A series of sensitivity analyses was conducted, including one to simulate the effect of a 24-week stopping rule for anti-TNF non-responders. Results Anti-TNF access criteria from France were satisfied by the largest proportion of DESIR patients (27.8%), followed by Germany (25.1%), Canada (23.8%), the UK (12.1%) and Hong Kong (8.6%). Confidence intervals around incremental costs and QALYs in the basecase analysis were overlapping, indicating that anti-TNF cost-effectiveness estimates derived from each subset were similar. In the sensitivity analysis that examined the effect of excluding costs accumulated past 24 weeks by anti-TNF non-responders, the incremental cost per QALY was reduced by approximately 25% relative to the basecase analysis (France: €857,992 vs. €1,105,859; Canada: € 626,459 vs. €818,186; Germany: € 422,568 vs. €545,808); UK €578,899 vs. €766,217; Hong Kong €335,418 vs. €456,850). Conclusions Anti-TNF cost-effectiveness is strongly affected by treatment continuation among non-responders. Access criteria could improve anti-TNF cost-effectiveness by defining patients likely to respond. |
| first_indexed | 2024-12-20T14:40:54Z |
| format | Article |
| id | doaj.art-92b57157561340e0a09f8f14611d70eb |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-12-20T14:40:54Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-92b57157561340e0a09f8f14611d70eb2022-12-21T19:37:18ZengBMCCost Effectiveness and Resource Allocation1478-75472017-09-0115111310.1186/s12962-017-0081-8Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimatesStephanie Harvard0Daphne Guh1Nick Bansback2Pascal Richette3Alain Saraux4Bruno Fautrel5Aslam Anis6University of British ColumbiaCentre for Health Evaluation and Outcome SciencesUniversity of British ColumbiaUniversity Paris Diderot, Faculty of MedicineRheumatology Unit, Hôpital de la Cavale BlancheSorbonne Universités, UPMC-GRC08, Pierre Louis Institute for Epidemiology and Public HealthUniversity of British ColumbiaAbstract Background Anti-tumor necrosis factor (anti-TNF) agents are an effective, but costly, treatment for spondyloarthritis (SpA). Worldwide, multiple sets of access criteria aim to restrict anti-TNF therapy to patients with specific clinical characteristics, yet the influence of access criteria on anti-TNF cost-effectiveness is unknown. Our objective was to use data from the DESIR cohort, a prospective study of early SpA patients in France, to determine whether the French anti-TNF access criteria are the most cost-effective in that setting relative to other potential restrictions. Methods We used data from the DESIR cohort to create five study populations of patients meeting anti-TNF access criteria from Canada, France, Germany, United Kingdom, and Hong Kong, respectively. For each study population, we calculated the costs and quality-adjusted life years (QALYs) over 1 year of patients treated and not treated with anti-TNF therapy. To control for differences between anti-TNF users and non-users, we used linear regression models to derive adjusted mean costs and QALYs. We calculated incremental cost-effectiveness ratios (ICERs) representing the incremental cost per additional QALY gained by treating with an anti-TNF within each of the five study populations, using bootstrapping to explore the range of uncertainty in costs and QALYs. A series of sensitivity analyses was conducted, including one to simulate the effect of a 24-week stopping rule for anti-TNF non-responders. Results Anti-TNF access criteria from France were satisfied by the largest proportion of DESIR patients (27.8%), followed by Germany (25.1%), Canada (23.8%), the UK (12.1%) and Hong Kong (8.6%). Confidence intervals around incremental costs and QALYs in the basecase analysis were overlapping, indicating that anti-TNF cost-effectiveness estimates derived from each subset were similar. In the sensitivity analysis that examined the effect of excluding costs accumulated past 24 weeks by anti-TNF non-responders, the incremental cost per QALY was reduced by approximately 25% relative to the basecase analysis (France: €857,992 vs. €1,105,859; Canada: € 626,459 vs. €818,186; Germany: € 422,568 vs. €545,808); UK €578,899 vs. €766,217; Hong Kong €335,418 vs. €456,850). Conclusions Anti-TNF cost-effectiveness is strongly affected by treatment continuation among non-responders. Access criteria could improve anti-TNF cost-effectiveness by defining patients likely to respond.http://link.springer.com/article/10.1186/s12962-017-0081-8Cost-effectivenessAnti-TNFBiologicsPharmaceutical policySpondyloarthritis |
| spellingShingle | Stephanie Harvard Daphne Guh Nick Bansback Pascal Richette Alain Saraux Bruno Fautrel Aslam Anis Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates Cost Effectiveness and Resource Allocation Cost-effectiveness Anti-TNF Biologics Pharmaceutical policy Spondyloarthritis |
| title | Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates |
| title_full | Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates |
| title_fullStr | Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates |
| title_full_unstemmed | Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates |
| title_short | Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates |
| title_sort | access criteria for anti tnf agents in spondyloarthritis influence on comparative 1 year cost effectiveness estimates |
| topic | Cost-effectiveness Anti-TNF Biologics Pharmaceutical policy Spondyloarthritis |
| url | http://link.springer.com/article/10.1186/s12962-017-0081-8 |
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