Table 3

ICERs of biological agents published in cost-effectiveness analyses

DrugStudy, PYRICER (year of pricing, if specified and different from year of publication)Tested versus
AdalimumabChiou et al 200442#m(c): dominated by ETA (+MTX)Anakinra (+MTX)
Bansback et al 200541#**m: 41,561 € (2001)DMARD
#**c: 34,167 €
Chen et al 200628§ (first line), m: 53,000 £ (2004)DMARD
§ (first line), c: 171,000 £
# (last active), m: 40,000 £
# (last active), c: 30,000 £
s: following ETA 240,000 £
following IFX+MTX 140,000 £
Spalding 200629§m: 63,769 US$MTX
§c: 194,589 US$
Brennan et al 200739#**m: 23,280 £DMARD
#**c: 27,111 £
s: 24,320 £
Wailoo et al 200840ADA and ETA are equally likely to be cost effective at a threshold of 110,000 US$
Probability of cost effectiveness at a threshold of 60,000 US$: 0.59
Davies et al 200932§c: 23,377 US$DMARD
EtanerceptChoi et al 200055#m: dominated
#c: 34,800 US$ per ACR70 WR, and 42,600 $US per ACR20 WR
Choi et al 20022040,800 US$ per patient with ACR70 WR (1999)MTX
41,900 US$ per ACR20 WRSSZ
Jobanputra et al 200252#**: 72,000 £ (2000)DMARD
Brennan et al 200445#**m: 16,330 £ (2001), direct costs only
indirect costs included: 8,439 £
Chiou et al 200442ADA and IFX where dominated by ETAAnakinra
#m: 13,387 US$ (2003)Anakinra+MTX
#c: 7,925 US$
Kobelt 200444#**c: ETA and IFX ITT 53,600 € (2002)
Welsing et al 200436#**: 163,556 £ (2002)DMARD
dominated by LEF(in case of non-response after 3 months)switch to ETA
Bansback et al 200541#**m: 36,927 €DMARD
#**c: 35,760 €
Kobelt et al 200543#c: 46,494 € (2004) (treatment for 10 years)DMARD
Chen et al 200628§ (first line), m: 49,000 £ (2004)DMARD
§ (first line), c: 78,000 £
# (last active), m: 24,000 £
# (last active), c: 24,000 £
s: following ADA 52,000 £
following IFX+MTX 47,000 £
following ADA and IFX as 3rd TNFi 54,900 £
Coyle et al 200653#**m: 144,700 Can$ (2003)DMARD
last after gold 125,700 Can$
Spalding and Hay 200629§m: 89,772 US$ (2004)MTX
Brennan et al 200739#**m: 23,280 £DMARD
#**c: 27,111 £
s: 24,320 £
Wailoo et al 200840ADA and ETA are equally likely to be cost effective at a threshold of 110,000 US$
Probability of cost effectiveness at a threshold of 60,000 US$: 0.41
Fautrel et al 2008 AB30 31§m: 24,655 € in severe RA, 30,199 € in highly active RA2nd line ETA added to MTX.
34,560 € in severe RA, 35,158 € in highly active RANo TNFi
Davies et al 200932§m: dominatedDMARD
s: following MTX+ADA, 19,663 US$DMARD
following MTX+ADA, 42,727 US$Single TNFi
InfliximabJobanputra et al 200252#**: 95,000 £ (2000)DMARD
Wong et al 200249#c: 30,500 US$ (1998) (9,100 US$ incuding indirect costs)DMARD
Kobelt et al 200348#c: 29,900 £ (UK), 16,100 € (Sweden) (2000)
Chiou et al 200442#c: dominated by ETAAnakinra+MTX
Kobelt et al 200444#**c: ETA and IFX ITT 53,600 € (2002)
Barbieri et al 200547#c: 33,618 £
Bansback et al 200541#**c: 48,333 €DMARD
Chen et al 200628§ (first line), c: 654,000 £ (2004)DMARD
# (last active), c: 38,000 £DMARD
s: following ADA 240,000 £DMARD
following ETA 190,000 £
Coyle et al 200653#**c: 113,000 Can$ (2003)DMARD
last after gold: 97,800 Can$
Spalding and Hay 200629§c: 409,523 US$ (2004)MTX
Brennan et al 200739#**m: 23,280 £DMARD
#**c: 27,111 £
s: 24,320 £
Marra et al 200746#c: 32,018 Can$ (2004) (HUI3), 46,322 (EQ-5D), 53,429 (HUI2), 69,826 (SF-6D), depending on the utility measure used to derive QALYs
Wailoo et al 200840Probability of cost effectiveness at a threshold of 60,000 US$: 0.00
Sensitivity analysis: scenario ‘no dose increase for IFX’: probability of cost effectiveness at a threshold of 60,000 US$: 1.00
Davies et al 200932§c: dominated
TNFiNSFinckh et al 200921§c: 727 894 US$
§c: dominated
DMARDFinckh et al 200921§m: 4849 US$
  • § DMARD naïve (ie, first-line treatment),

  • # after DMARD failure

  • (*after failure of one DMARD,

  • ** after failure of more than one DMARD),

  • In their analyses, the authors also differentiated between ‘early RA’ and ‘first-line TNFi’, as well as between ‘late RA’ and ‘TNFiused as last drug’ yet ICERs reported did not differ substantially).

  • AB; published in abstract form only; ADA, adalimumab; c, combination therapy (with MTX, if not otherwise stated); DMARD, disease-modifying antirheumatic drug; ETA, etanercept; ICER, incremental cost-effectiveness ratio; IFX, infliximab; ITT, intention to treat analysis; m, monotherapy; MTX, methotrexate; NS, not specified; NSAIDs, non-steroidal anti-inflammatory drugs; PYR, year of publication; QALY, quality-adjusted life-year; RA, rheumatoid arthritis; s, sequential use; SSZ, sulfasalazine; TNFi, TNFa inhibitors; WR, weighted response.