Results of scenario analyses
| Scenario | Societal perspective (2.5–97.5% percentile) | Healthcare perspective (2.5–97.5% percentile) |
|---|---|---|
| 1. EULAR good response | ||
| Cost diff | −€ 1 999 594 (−2 628 427 to −1 376 991) | −€ 1 967 523 (−2 575 581 to −1 378 044) |
| QALY diff | 8.53 (−4.71 to 22.05) | 8.53 (−4.71 to 22.05) |
| ICER | −€ 233 200/QALY | −€ 225 450/QALY |
| % (Q1,Q2,Q3,Q4) | 89, 11, 0, 0 | 89, 11, 0, 0 |
| 2. Abatacept | ||
| Cost diff | −€ 2 475 546 (−3 123 416 to −1 792 839) | −€ 2 585 592 (−3 090 176 to −1 813 623) |
| QALY diff | 3.75 (−8.24 to 16.03) | 3.75 (−8.24 to16.03) |
| ICER | −€ 659 845/QALY | −€ 689 500/QALY |
| % (Q1,Q2,Q3,Q4) | 73, 27, 0, 0 | 73, 27, 0, 0 |
| 3. Utility loss and extra costs for non-TNF-inhibiting biological | ||
| Cost diff | −€ 2 500 298 (−3 168 398 to −1 816 060) | −€ 2 532 520 (−3 139 230 to −1 846 444) |
| QALY diff | −4.70 (−16.96 to 7.45) | −4.70 (−16.96 to 7.45) |
| ICER | −€ 531 570/QALY | −€ 538 421/QALY |
| % (Q1,Q2,Q3,Q4) | 23, 77, 0, 0 | 23, 77, 0, 0 |
| 4. Abatacept+utility loss and extra costs for non-TNF-inhibiting biological | ||
| Cost diff | −€ 2 496 757 (−3 184 331 to −1 828 609) | −€ 2 671 528 (−3 126 653 to −1 838 130) |
| QALY diff | −4.81 (−16.98 to 7.73) | −4.81 (−16.98 to 7.73) |
| ICER | −€ 519 571/QALY | −€ 530 914/QALY |
| % (Q1,Q2,Q3,Q4) | 22, 78, 0, 0 | 22, 78, 0, 0 |
| 5. EULAR good response+abatacept+utility loss and extra costs for non-TNF-inhibiting biological | ||
| Cost diff | −€ 1 588 478 (−2 233 077 to 169 235) | −€ 1 979 837 (−2 157 080 to−969 718) |
| QALY diff | −6.45 (−19.98 to 7.58) | −6.45 (−19.98 to 7.58) |
| ICER | −€ 246 228/QALY | −€ 244 030/QALY |
| % (Q1,Q2,Q3,Q4) | 18, 82, 0, 0 | 18, 82, 0, 0 |
| 6. stricter drug level cut-offs | ||
| Cost diff | −€ 2 198 829 (−2 845 213 to −1 546 767) | −€ 2 051 150 (−2 794 594 to −1 558 940) |
| QALY diff | 4.20 (−8.19 to 16.88) | 4.20 (−8.19 to16.88) |
| ICER | −€ 523 668/QALY | −€ 488 497/QALY |
| % (Q1,Q2,Q3,Q4) | 74, 26, 0,0 | 74, 26, 0, 0 |
| 7. EULAR good response+stricter drug level cut-offs | ||
| Cost diff | −€ 2.090.551 (−2 720 828 to −1 463 210) | −€ 2 108 341 (−2 644 244 to −1 464 647) |
| QALY diff | 10.67 (−4.32 to 26.15) | 10.67 (−4.32 to 26.15) |
| ICER | −€ 196 006/QALY | −€ 174 448/QALY |
| % (Q1,Q2,Q3,Q4) | 92, 8, 0,0 | 92, 8, 0, 0 |
| 8. Undiscounted | ||
| Cost diff | −€ 2 590 772 (−3 275 690 to −1 922 325) | −€ 2 233 283 (−3 220 860 to −1 931 872) |
| QALY diff | 3.69 (−8.33 to 15.78) | 3.69 (−8.33 to 15.78) |
| ICER | −€ 700 751/QALY | −€ 746 602/QALY |
| % (Q1,Q2,Q3,Q4) | 72, 28, 0, 0 | 72, 28, 0, 0 |
Scenario 1: Use of EULAR good response instead of EULAR moderate response as response criteria for treatment algorithm. Scenario 2: The use of abatacept, a more expensive non-tumour necrosis factor (TNF)-inhibiting biological, instead of rituximab. Scenario 3: Loss in utility and extra costs (eg, regarding toxicity) for non-TNF-inhibiting biologicals. Scenario 4: scenario 2+3. Scenario 5: scenario 1+2+3. Scenario 6: Change cut-off for low drug levels from 5 mg/L to 2 mg/L and for high drug level from 5–12 mg/L to 2–12 mg/L. Scenario 7: scenario 1+6. Scenario 8: Undiscounted values for costs and effects.
Q1 is S-E quadrant, Q2 is S-W quadrant, Q3 is N-W quadrant, Q4 is N-E quadrant of cost-effectiveness plane.
EULAR, European league against rheumatism; ICER, incremental cost effectiveness ratio; QALY, quality adjusted life year.