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FRI0155 Long-term cost-utility analysis of treatment strategies in patients with recent-onset rheumatoid arthritis – 5 year follow-up data from the best study
  1. W. van den Hout1,
  2. N. Klarenbeek2,
  3. L. Dirven3,
  4. P. Kerstens4,
  5. T. Huizinga2,
  6. W. Lems4,
  7. C. Allaart2
  1. 1Department of Medical Decision Making
  2. 2Rheumatology, LUMC, Leiden
  3. 3Rheumatology, VUmc
  4. 4Rheumatology, JBI/Reade, Amsterdam, Netherlands

Abstract

Objectives To evaluate 5-year costs and quality-adjusted life years (QALYs) of treatment strategies for patients with recent-onset active rheumatoid arthritis (RA).

Methods Patients (n=508) were randomly allocated to one of the following four treatment strategies: 1. sequential monotherapy, 2. step-up combination therapy, 3. initial combination therapy with prednisone, or 4. initial combination therapy with infliximab. The current analysis includes the outcome measures that were significantly different in the 2-year analysis: study medication, QALYs based on the EQ5D and SF6D, and paid labour. Data were analyzed using multiple imputation, combined with ANOVA and net benefit analysis. In separate analyses, both the friction cost method and the human capital approach were used to value productivity.

Results Treatment patterns continued to differ during the follow-up period. In the fifth year, the percentages of patients receiving infliximab in groups 1-4 were 20%, 6%, 13%, and 22%, respectively (P=0.002). Costs of study medication were largely determined by the use of infliximab and over the five-year period amounted to 14000, 5000, 9000, and 26000 euro (P<0.001).

QALYs were significantly better in group 4 during the first two years (P<0.04). In later years, there were no significant differences between the groups. Total QALYs in groups 1-4 (ideally 5.0) amounted to 3.08, 2.98, 3.07, and 3.28 according to the EQ5D (P=0.06) and 3.26, 3.19, 3.24, and 3.34 according to the SF6D (P=0.16).

Differences in paid labour decreased over time, but remained in favour of strategy 4 (P<0.06). Using the friction cost method to value productivity, the cost-utility ratio for group 4 against the next best alternative was estimated at €76,000 per QALY. Using the human capital approach to value productivity, the savings on paid labour in group 4 exceeded the higher medication costs in group 4.

Conclusions Initial combination therapy with infliximab for patients with recent-onset active RA resulted in significantly better 2-year quality of life than the other strategies. After 2 years, the outcome differences between the strategies decreased, but differences in medication costs and paid labour remained. Using the friction cost method to value productivity, the higher costs of initial combination therapy with infliximab are generally considered too high. Giving full weight to the sustained productivity using the human capital approach, the higher costs of initial combination therapy with infliximab were more than compensated.

Disclosure of Interest W. van den Hout Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough), N. Klarenbeek Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough), L. Dirven Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough), P. Kerstens Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough), T. Huizinga Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough), W. Lems Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough), C. Allaart Grant/Research support from: Dutch College of Health Insurances, Centocor Inc. and MSD (formerly Schering-Plough)

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