Analisi costo efficacia di Etanercept vs. Adalimumab nel trattamento dell’artrite reumatoide in Italia

Autori: Giorgio L. Colombo, Giulio Serra, Gianni Leardini

Objective

This study compares the cost effectiveness of Etanercept and Adalimumab used in the treatment of rheumatoid arthritis.

Methods

A decision analytic model was constructed to estimate the costs and effectiveness of these drugs used alone or in combination with Methotrexate during 1 year from NHS perspective. The direct costs consisted of drugs and healthcare resources. Effectiveness was measured by quality-adjusted life years (QALYs) based on preference weights and health states in which patients achieved one of four levels of response according to the American College of Rheumatology (ACR) response criteria (NO ACR, ACR20, ACR50 and ACR70) and experience one of the four levels of adverse events (e.g. no, mild, moderate and severe) due to their treatments.

Results

For monotherapy the average cost-effectiveness per successfully treated patient, achieving the ACR20, for Etanercept was € 19,129 compared to € 29,242 for Adalimumab (every two week). For combination therapy Etanercept + Methotrexate vs. Adalimumab + Methotrexate resulted a cost effectiveness ratio € 16,897 and € 20,293 to reach the ACR20, respectively. Moreover, the cost per gained QALY in the passage from the treatment with Adalimumab 40 mg every other week to Etanercept is equal to € 2,251 for monotherapy and to € 7,042 for the combined therapy. Adalimumab 40 mg/ week is dominated by Etanercept. Results were sensitive to changes in treatment costs and probabilities of health states in directions as predicted.

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