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  • Cost effectiveness of two therapeutic regimens of infliximab in ankylosing spondylitis: economic evaluation within a randomised controlled trial

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Clinical and epidemiological research
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Cost effectiveness of two therapeutic regimens of infliximab in ankylosing spondylitis: economic evaluation within a randomised controlled trial
  1. B Fautrel1,2,
  2. M Benhamou1,2,
  3. M Breban3,4,
  4. C Roy5,6,
  5. C Lenoir7,
  6. G Trape7,
  7. A Baleydier8,
  8. P Ravaud5,6,9,
  9. M Dougados10,11
  1. 1
    APHP, Groupe hospitalier Pitié-Salpêtrière, Service of Rhumatologie, Paris, France
  2. 2
    Université Paris VI – Pierre et Marie Curie, UFR de médecine, Paris, France
  3. 3
    APHP, Hôpital Ambroise Paré, Service of Rhumatologie, Boulogne-Billancourt, France
  4. 4
    Institut Cochin, INSERM U567, CNRS UMR8104, Université Paris 5, Paris
  5. 5
    INSERM U738, Paris, France
  6. 6
    APHP, Groupe hospitalier Bichat-Claude Bernard, Département d’Epidémiologie, Biostatistique et Recherche Clinique, Paris, France
  7. 7
    Schering-Plough Pharmaceuticals, Levallois, France
  8. 8
    RCTS, Vaulx-en-Velin, France
  9. 9
    Université Paris VII – Denis Diderot, Faculté Xavier Bichat, Paris, France
  10. 10
    APHP, Hôpital Cochin, Service de Rhumatologie B, Paris, France
  11. 11
    Université Paris V – René Descartes, UFR de médecine, Paris, France
  1. 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

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.

http://dx.doi.org/10.1136/ard.2008.103887

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    Footnotes

    • ▸ An additional figure and table are published online only at http://ard.bmj.com/content/vol69/issue2

    • Funding The study was funded by Schering-Plough.

    • Competing interests Honorarium from Schering-Plough France, Abbott and Wyeth.

    • Ethics approval Ethics committee approval from CPP d'Ile de France, Paris.

    • Patient consent Patient consent received.

    • 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.

    • Provenance and Peer review Not commissioned; externally peer reviewed.