Cost effectiveness of two therapeutic regimens of infliximab in ankylosing spondylitis: economic evaluation within a randomised controlled trial
- B Fautrel1,2,
- M Benhamou1,2,
- M Breban3,4,
- C Roy5,6,
- C Lenoir7,
- G Trape7,
- A Baleydier8,
- P Ravaud5,6,9,
- M Dougados10,11
- 1APHP, Groupe hospitalier Pitié-Salpêtrière, Service of Rhumatologie, Paris, France
- 2Université Paris VI – Pierre et Marie Curie, UFR de médecine, Paris, France
- 3APHP, Hôpital Ambroise Paré, Service of Rhumatologie, Boulogne-Billancourt, France
- 4Institut Cochin, INSERM U567, CNRS UMR8104, Université Paris 5, Paris
- 5INSERM U738, Paris, France
- 6APHP, Groupe hospitalier Bichat-Claude Bernard, Département d’Epidémiologie, Biostatistique et Recherche Clinique, Paris, France
- 7Schering-Plough Pharmaceuticals, Levallois, France
- 8RCTS, Vaulx-en-Velin, France
- 9Université Paris VII – Denis Diderot, Faculté Xavier Bichat, Paris, France
- 10APHP, Hôpital Cochin, Service de Rhumatologie B, Paris, France
- 11Université Paris V – René Descartes, UFR de médecine, Paris, France
- Correspondence to Professor B Fautrel, Pierre et Marie Curie University (Paris VI); Department of Rheumatology, Pitie Salpetriere Hospital, 83 boulevard de l’Hôpital, 75651 Paris cedex 13, France; bruno.fautrel{at}psl.aphp.fr
- Accepted 24 July 2009
- Published Online First 9 September 2009
Abstract
Objective: To determine the incremental cost-effectiveness ratios (ICERs) of two therapeutic regimens of infliximab for ankylosing spondylitis (AS).
Methods: 230 patients with active AS who were participating in a randomised controlled trial comparing two infliximab infusion modalities—every 6 weeks (Q6) and on demand (DEM)—were included in an economic evaluation within the trial. Data were collected by phone every 3 months for 1 year. Direct and indirect costs were calculated from a payer perspective. Health-related quality of life was assessed with a general health rating scale. ICERs were calculated for one 20% improvement (ASAS20), for one partial remission and for one quality-adjusted life year (QALY) gained.
Results: The Q6 regimen was significantly more efficacious than the DEM regimen but also more costly (€22 388 vs €17 596; p<0.001), because it required significantly more infliximab infusions per patient (8.4 vs 6.2). The ICERs of the Q6 to DEM regimen were €15 841 for one ASAS20 response, €23 296 for one partial remission and €50 760 for one QALY gained.
Conclusion: The administration of infliximab every 6 weeks is cost effective as compared with a DEM regimen; however, the ICER is close to the acceptability threshold of €50 000 for one QALY gained.
Trial registration number: NCT 00439283.
Footnotes
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▸ An additional figure and table are published online only at http://ard.bmj.com/content/vol69/issue2
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Funding The study was funded by Schering-Plough.
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Competing interests Honorarium from Schering-Plough France, Abbott and Wyeth.
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Ethics approval Ethics committee approval from CPP d'Ile de France, Paris.
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Patient consent Patient consent received.
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Role of the authors in the study: Study design: Fautrel, Breban, Lenoir, Ravaud, Trape, Dougados. Analysis and interpretation of data: Fautrel, Benhamou, Roy, Ravaud. Manuscript preparation: Fautrel, Benhamou, Breban, Ravaud, Dougados.
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Provenance and Peer review Not commissioned; externally peer reviewed.
