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Cost-Effectiveness of Biologic Agents for Treatment of Autoimmune Disorders: Structured Review of the Literature
RACHAEL FLEURENCE and ELDON SPACKMAN ABSTRACT Objective. Four new biologic treatments have been approved for several autoimmune disorders. Economic evaluations have been used to model their cost-effectiveness. Methods. We conducted a structured literature review in Embase and PubMed to identify all relevant cost-effectiveness models investigating one or more of these 4 drugs in autoimmune disorders. Results. Fifteen full economic evaluations were identified [13 for rheumatoid arthritis (RA), 2 for Crohn's disease (CD), and 1 for ankylosing spondylitis (AS)]. While several studies found adalimumab, etanercept, and infliximab to be cost-effective (using a threshold around $50,000/quality-adjusted life-year) for treatment of severe RA, not all studies concurred, and there was significant variation in the range of cost-effectiveness ratios reported. Neither study in CD found treatment with infliximab to be cost-effective. Only one study was identified in AS: treatment with infliximab was found to be cost-effective. Conclusion. Modeling treatment strategies in chronic relapsing diseases such as RA, CD, and AS presents particular challenges, as reflected in the variation in cost-effectiveness results reported. A reference case for economic evaluations, such as that suggested by the OMERACT (Outcome Measures in Rheumatology) Health Economics Working Group will facilitate comparison and interpretation of results. (J Rheumatol 2006;33:2124-31) Key Indexing Terms:
RHEUMATOID ARTHRITIS From the Health Care Analytics Group, United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, Maryland; and the Department of Pharmacy, University of Washington, Seattle, Washington, USA. United BioSource Corporation consults for several of the companies manufacturing the biologic agents reviewed in this study. These companies were not involved in the funding, conception, development, and writing of this report. R.L. Fleurence, PhD, Health Care Analytics Group, United BioSource; E. Spackman, MA, Health Care Analytics Group, United BioSource and Department of Pharmacy, University of Washington. Address reprint requests to R.L. Fleurence, Health Care Analytics Group, United BioSource Corporation, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. E-mail: rachael.fleurence@unitedbiosource.com Accepted for publication July 7, 2006.
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