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Cost-effectiveness of two therapeutic regimens of infliximab in ankylosing spondylitis: economic evaluation within a randomized controled trial
  1. Bruno Fautrel (bruno.fautrel{at}psl.aphp.fr)
  1. Pierre et Marie Curie - Paris VI University, France
    1. Mathilde Benhamou
    1. Pierre et Marie Curie - Paris VI University, France
      1. Maxime Breban
      1. INSERM U567, Paris, France
        1. Carine Roy
        1. INSERM U738, Paris, France
          1. Christelle Lenoir
          1. Schering Plough France, France
            1. Gérard Trape
            1. Schering Plough France, France
              1. Alain Baleydier
              1. RCTs, Lyon, France
                1. Philippe Ravaud
                1. INSERM U738, Paris, France
                  1. Maxime Dougados
                  1. University Paris V - René Descartes, France

                    Abstract

                    Objective: To determine the incremental cost-effectiveness ratios (ICERs) of 2 therapeutic regimens of infliximab for ankylosing spondylitis (AS).

                    Methods: 230 patients with active AS who were participating in a randomized controlled trial comparing 2 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<0.0001), 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.

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