Titre du document / Document title

Cost effectiveness of adding leflunomide to a 5-year strategy of conventional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis

Auteur(s) / Author(s)

MAETZEL Andreas ⁽¹⁾ ; STRAND Vibeke ⁽²⁾ ; TUGWELL Peter ⁽³⁾ ; WELLS George ⁽³⁾ ; BOMBARDIER Claire ⁽⁴⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ University Health Network Research Institute, Toronto, Ontario, CANADA
⁽²⁾ Stanford University, Stanford, California, ETATS-UNIS
⁽³⁾ University of Ottawa, Ottawa, Ontario, CANADA
⁽⁴⁾ University Health Network, University of Toronto, and Mt. Sinai Hospital, Toronto, Ontario, CANADA

Résumé / Abstract

Objective. To estimate, from a public payer's perspective, the 5-year cost effectiveness of adding leflunomide (LEF) to a sequence of disease-modifying antirheumatic drugs (DMARDs) representative of a typical rheumatoid arthritis (RA) management approach adopted by Canadian rheumatologists. Methods. A DMARD sequence including LEF was compared with one excluding it, using a 5-year simulation model where patients with RA cycle through different treatment regimens. Data were obtained through a systematic literature search (drug withdrawal rates, number and type of adverse events, American College of Rheumatology 20% responder status) and separately conducted surveys (choice of DMARD sequence, management of adverse events). Costs for adverse event management were calculated using the Ontario Schedule of Benefits, and monitoring costs were calculated according to official Canadian product monograph recommendations. Wholesale prices of all drugs were adjusted by the allowable markup and prescription fees. Utilities (as measured by the standard gamble [SG] and rating scale [RS] techniques) were obtained from 482 patients who participated in a 1-year randomized controlled trial that compared LEF, methotrexate, and placebo. Costs and utilities were discounted by 3%. Probabilistic sensitivity analysis was performed. Results. Adding LEF to a conventional strategy of DMARDs increased the 5-year management costs by $1,231 compared with the strategy without LEF, which results in a cost-effectiveness ratio of $13,096 per additional year of response to treatment, and cost-utility ratios of $54,229 (RS) and $71,988 (SG) per quality-adjusted life-year gained. Conclusion. Adding LEF as a new option to a conventional sequence of DMARDs extends the time patients may benefit from DMARD therapy at a reasonable cost effectiveness and cost utility. LEF data are limited to clinical trials; data from observational studies would be needed to corroborate these findings.

Revue / Journal Title

Arthritis care and research   ISSN 0893-7524   CODEN ARCREG 

Source / Source

2002, vol. 47, n^o6, pp. 655-661 [7 page(s) (article)] (22 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams and Wilkins, Hagerstown, MD, ETATS-UNIS  (1988) (Revue)

Mots-clés anglais / English Keywords

Autoimmune disease ; Immunopathology ; Inflammatory joint disease ; Diseases of the osteoarticular system ; Isoxazole derivatives ; Chronic ; Models ; Human ; Cost efficiency analysis ; Treatment efficiency ; Antirheumatic agent ; Application method ; Leflunomide ; Chemotherapy ; Treatment ; Rheumatoid arthritis ;

Mots-clés français / French Keywords

Maladie autoimmune ; Immunopathologie ; Rhumatisme inflammatoire ; Système ostéoarticulaire pathologie ; Isoxazole dérivé ; Chronique ; Modèle ; Homme ; Analyse coût efficacité ; Efficacité traitement ; Antirhumatismal ; Modalité traitement ; Léflunomide ; Chimiothérapie ; Traitement ; Polyarthrite rhumatoïde ;

Mots-clés espagnols / Spanish Keywords

Enfermedad autoinmune ; Inmunopatología ; Reumatismo inflamatorio ; Sistema osteoarticular patología ; Crónico ; Modelo ; Hombre ; Análisis costo eficacia ; Eficacia tratamiento ; Antireumático ; Modalidad tratamiento ; Leflunomida ; Quimioterapia ; Tratamiento ; Poliartritis reumatoidea ;

Mots-clés d'auteur / Author Keywords

Leflunomide ; Cost effectiveness ; Rheumatoid arthritis ;

Localisation / Location

INIST-CNRS, Cote INIST : 21540, 35400010380443.0130