Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model
<p><strong>Aims: </strong>To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren’s disease (DD) and the value of further research from an NHS perspective.</p> <p><stro...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
British Editorial Society of Bone and Joint Surgery
2022
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| _version_ | 1826309504659095552 |
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| author | Dakin, H Rombach, I Dritsaki, M Gray, A Ball, C Lamb, SE Nanchahal, J |
| author_facet | Dakin, H Rombach, I Dritsaki, M Gray, A Ball, C Lamb, SE Nanchahal, J |
| author_sort | Dakin, H |
| collection | OXFORD |
| description | <p><strong>Aims: </strong>To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren’s disease (DD) and the value of further research from an NHS perspective.</p>
<p><strong>Methods: </strong>We used data from the Repurposing anti-TNF for Dupuytren’s disease (RIDD) randomized controlled trial of intranodular adalimumab injections in patients with early-stage progressive DD. RIDD found that intranodular adalimumab injections reduced nodule hardness and size in patients with early-stage DD, indicating the potential to control disease progression. A within-trial cost-utility analysis compared four adalimumab injections with no further treatment against standard care alone, taking a 12-month time horizon and using prospective data on EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and resource use from the RIDD trial. We also developed a patient-level simulation model similar to a Markov model to extrapolate trial outcomes over a lifetime using data from the RIDD trial and a literature review. This also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded.</p>
<p><strong>Results: </strong>The within-trial economic evaluation found that adalimumab plus standard care cost £503,410 per quality-adjusted life year (QALY) gained versus standard care alone over a 12-month time horizon. The model-based extrapolation suggested that, over a lifetime, repeated courses of adalimumab could cost £14,593 (95% confidence interval £7,534 to £42,698) per QALY gained versus standard care alone. If the NHS was willing to pay £20,000/QALY gained, there is a 77% probability that adalimumab with retreatment is the best value for money.</p>
<p><strong>Conclusion: </strong>Repeated courses of adalimumab are likely to be a cost-effective treatment for progressive early-stage DD. The value of perfect parameter information that would eliminate all uncertainty around the parameters estimated in RIDD and the duration of quiescence was estimated to be £105 per patient or £272 million for all 2,584,411 prevalent cases in the UK.</p> |
| first_indexed | 2024-03-07T07:35:12Z |
| format | Journal article |
| id | oxford-uuid:a1454513-8af6-4c95-8337-a8ff0558c61c |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:35:12Z |
| publishDate | 2022 |
| publisher | British Editorial Society of Bone and Joint Surgery |
| record_format | dspace |
| spelling | oxford-uuid:a1454513-8af6-4c95-8337-a8ff0558c61c2023-03-08T07:30:36ZCost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation modelJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:a1454513-8af6-4c95-8337-a8ff0558c61cEnglishSymplectic ElementsBritish Editorial Society of Bone and Joint Surgery2022Dakin, HRombach, IDritsaki, MGray, ABall, CLamb, SENanchahal, J<p><strong>Aims: </strong>To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren’s disease (DD) and the value of further research from an NHS perspective.</p> <p><strong>Methods: </strong>We used data from the Repurposing anti-TNF for Dupuytren’s disease (RIDD) randomized controlled trial of intranodular adalimumab injections in patients with early-stage progressive DD. RIDD found that intranodular adalimumab injections reduced nodule hardness and size in patients with early-stage DD, indicating the potential to control disease progression. A within-trial cost-utility analysis compared four adalimumab injections with no further treatment against standard care alone, taking a 12-month time horizon and using prospective data on EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and resource use from the RIDD trial. We also developed a patient-level simulation model similar to a Markov model to extrapolate trial outcomes over a lifetime using data from the RIDD trial and a literature review. This also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded.</p> <p><strong>Results: </strong>The within-trial economic evaluation found that adalimumab plus standard care cost £503,410 per quality-adjusted life year (QALY) gained versus standard care alone over a 12-month time horizon. The model-based extrapolation suggested that, over a lifetime, repeated courses of adalimumab could cost £14,593 (95% confidence interval £7,534 to £42,698) per QALY gained versus standard care alone. If the NHS was willing to pay £20,000/QALY gained, there is a 77% probability that adalimumab with retreatment is the best value for money.</p> <p><strong>Conclusion: </strong>Repeated courses of adalimumab are likely to be a cost-effective treatment for progressive early-stage DD. The value of perfect parameter information that would eliminate all uncertainty around the parameters estimated in RIDD and the duration of quiescence was estimated to be £105 per patient or £272 million for all 2,584,411 prevalent cases in the UK.</p> |
| spellingShingle | Dakin, H Rombach, I Dritsaki, M Gray, A Ball, C Lamb, SE Nanchahal, J Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model |
| title | Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model |
| title_full | Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model |
| title_fullStr | Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model |
| title_full_unstemmed | Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model |
| title_short | Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease: an economic evaluation based on a randomized controlled trial and individual-patient simulation model |
| title_sort | cost effectiveness of adalimumab for early stage dupuytren s disease an economic evaluation based on a randomized controlled trial and individual patient simulation model |
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