Analytic Choices in Economic Models of Treatments for Rheumatoid Arthritis: What Makes a Difference?

Medical Decision Making - Tập 25 Số 5 - Trang 520-533 - 2005
Michael Drummond1, Marco Barbieri2, John B. Wong3
1Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom; Innovus Research UK Ltd, High Wycombe, UK.
2Innovus Research UK Ltd, High Wycombe, UK; Universitat Pompeu Fabra, Barcelona, Spain
3Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Tóm tắt

Objectives. To compare the analytic judgments, data, and assumptions of different models used in the economic evaluation of infliximab, one of a new class of drugs for rheumatoid arthritis (RA). Methods. A detailed assessment was made of 4 models, 1 submitted (in a reimbursement dossier) by the manufacturer, 1 produced by an independent academic group, and 2 recently published in the literature. Factors considered included the key data inputs, assumptions about the sequencing of treatments for RA, the methods used to calculate health utilities, and the estimation of cost offsets. Results. Two of the 4 models, although embodying different methodological approaches, gave fairly similar results (approximately £25,000–£35,000 cost per additional quality-adjusted life year [QALY] gained). The other 2 models, both by an independent academic group, gave much higher estimates, ranging from £50,000 to £60,000 to more than £100,000 per additional QALY. The differences appeared to depend mainly on differences in model structure, the assumptions about the positioning of infliximab in the treatment sequence, and the relationship between Health Assessment Questionnaire (HAQ) states and QALYs. Conclusions. Economic models of treatments for RA incorporate different key data inputs and analytic judgments. However, convergence was observed in some of the estimates produced by the models, particularly when adjustments were made for some of the differences in input parameters. Nevertheless, differences in the choice of model structure and in key assumptions also had a major impact on results. Therefore, more discussion is needed to reach a consensus on some of these methodological issues.

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Tài liệu tham khảo

10.1001/jama.283.16.2116

10.1046/j.1524-4733.2003.00234.x

10.3310/hta8360

National Institute for Clinical Excellence, 2002, Guidance on the Use of Etanercept and Infliximab for the Treatment of Rheumatoid Arthritis

10.2165/00019053-200523060-00007

National Institute for Clinical Excellence, 2002, Technology Appraisal No. 36

10.1093/rheumatology/keg107

10.3310/hta8110

10.1016/S0140-6736(99)05246-0

10.1016/0197-2456(95)00134-4

Wiles N, 1999, Arch Intern Med, 26, 800

10.1056/NEJM200011303432202

10.1093/rheumatology/36.5.551

10.1016/S0002-9343(02)01243-3

Guedes C, 1999, Rev Rheum Engl Ed, 66, 492

Schering-Plough Ltd. Remicade [summary of product characteristics], 2004. Available from: http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=3236

Wyeth Pharmaceuticals. Enbrel [summary of product characteristics], 2004. Available from: http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=3343