Cost-effectiveness of early use of etanercept in the treatment of rheumatoid arthritis

Abstract

Objective: To compare the long-term cost-effectiveness of a sequential treatment strategy involving the early use of etanercept (ETN) with that for the conventional late use of ETN in Korean RA patients

Methods: A cost-effectiveness analysis was performed to compare two treatment sequences using etanercept with methotrexate: early versus late start to the rheumatoid arthritis (RA) patients in Korea. Decision analysis and Markov cohort simulation were used to extrapolate short-term clinical trial results to a long-term time horizon. The outcome was quantified as the qualityadjusted life years (QALYs). The 6-monthly trends in Health Assessment Questionnaire disability scores were simulated for 1,000 patients for 5and converted into QALYs. Direct medical costs including drugs and monitoring were estimated based on the Korean National Health Insurance reimbursement schedule.

Results: The incremental cost-effectiveness ratio for the early versus late use strategy was 78,101 thousand won per QALY gained, but this reduced to 30,012 thousand won, 6,620 thousand won, and –10,054 per QALY gained when the treatment period was changed to 10, 15, and 30years, respectively.

Conclusions: These results show that a sequential treatment strategy with early use of ETN in RA may not represent a cost-effective alternative to the conventional late use of ETN over a 5-year time horizon. However, scenario analyses showed that both the inclusion of indirect costs and long-term use might further improve the costeffectiveness outcomes for the early use of ETN.