Cost-effectiveness analysis of etanercept combined with methotrexate in the treatment of rheumatoid arthritis_Chinese Journal of Evidence-Based Medicine

Authors：

XIAO Dunming , SUN Amin , SUN Yuanyuan ,  YU Zheng

School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, P.R.China;

Corresponding author：

YU Zheng, Email: 1513370906@qq.com

Keywords：

Rheumatoid arthritis; Etanercept; Methotrexate; Meta-analysis; Cost-effectiveness analysis

DOI：

10.7507/1672-2531.201612060

Video：

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ObjectiveTo compare the cost-effectiveness of etanercept combined with methotrexate to methotrexate plus placebo in the treatment of rheumatoid arthritis and to provide references for clinical practice.MethodsDecision tree model was developed to estimate the cost-effectiveness from the perspective of the health care system by TreeAge Pro 2016 software. The cost-effectiveness of the two treatments were compared by incremental analysis, and the robustness of the results were analyzed by sensitivity analysis.ResultsThe cost of etanercept combined methotrexate group in one year duration was ¥212 692, the effective rate (ACR50) was 66.4%; the cost of methotrexate combined with placebo group in one year duration was ¥572, the effective rate (ACR50) was 40.6%. The incremental cost-effectiveness ratio of two groups was ¥818 000/person, and the sensitivity analysis showed that the results were robust.ConclusionEtanercept combined methotrexate is significant more effective than methotrexat. But the cost of etanercept combined methotrexate is too high to afford and is not economical compared to methotrexate.

Citation： XIAO Dunming, SUN Amin, SUN Yuanyuan, YU Zheng. Cost-effectiveness analysis of etanercept combined with methotrexate in the treatment of rheumatoid arthritis. Chinese Journal of Evidence-Based Medicine, 2017, 17(7): 843-847. doi: 10.7507/1672-2531.201612060 Copy

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18.	Emery P, Breedveld FC, Hall S, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet, 2008, 372(9636): 375-382.
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20.	孙艳坤, 刘国恩, 李幼平. 化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤的药物经济学系统评价. 中国循证医学杂志, 2013, 13(6): 700-708.

1. 国际ACR小组委员会. 类风湿性关节炎的治疗指南. 继续医学教育, 2005, 19(3): 67-73.
2. 苏妍, 徐高四, 涂卫平, 等. 英夫利西单抗联合甲氨蝶呤治疗类风湿性关节炎的 Meta 分析. 实用医学杂志, 2014, 33(13): 2142-2147.
3. 李瑞, 孟庆刚. 类风湿性关节炎的临床治疗研究. 中华中医药学刊, 2007, 25(7): 1348-1352.
4. 杨喜梅, 窦存瑞, 魏花萍. 阿达木单抗治疗对缓解抗风湿性药物无效的类风湿性关节炎的系统评价. 中国循证医学杂志, 2011, 11(1): 84-90.
5. 刘一, 刘恩溢, 黄琳, 等. 鹿瓜多肽注射液治疗类风湿性关节炎疗效及安全性的 Meta 分析. 中国药房, 2012, 23(20): 1890-1893.
6. 中华医学会风湿病学分会. 类风湿关节炎诊断及治疗指南. 中华风湿病学杂志, 2010, 14(4): 265-270.
7. 李向莲, 沈建通, 李幼平, 等. 胶囊内镜诊断小肠疾病的卫生技术评估. 中国循证医学杂志, 2014, 14(5): 541-553.
8. 钟黛云, 刘爱军, 骆楚君, 等. 射频消融术与胺碘酮比较治疗房颤的药物经济学评价. 中国循证医学杂志, 2015, 15(9): 1018-1023.
9. 刘国恩, 主编. 中国药物经济学评价指南及导读: 2015版. 北京: 科学出版社, 2015: 31-33.
10. 刘强, 李洪超, 马爱霞. 基于决策树模型对我国中重度抑郁症临床常用药物治疗方案选择的成本效果分析. 中国循证医学杂志, 2016, 16(6): 628-634.
11. 李鹤, 夏苏建. 类风湿性关节炎患者医疗费用影响因素研究. 中国病案, 2013, 14(10): 57-58.
12. Felson DT, Anderson JJ, Boers M, et al. American college of rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum, 1995, 38(6): 727-735.
13. 刘国恩, 张玉哲, 范丽亚, 等. 急性缺血性脑卒中三种常用神经保护药物成本-效果分析. 中国卫生经济, 2012, 31(8): 62-65.
14. Cochrane handbook for systematic reviews of interventions version 5. 3. Available at: htttp:www.cochranehandbook.org.
15. 陈群飞, 王莉, 李幼平, 等. γ-干扰素释放试验筛查潜伏性结核患者的成本效果分析. 中国循证医学杂志, 2011, 11(7): 768-774.
16. 刘国恩, 主编. 中国药物经济学评价指南及导读: 2015版. 北京: 科学出版社, 2015: 126-130.
17. Klareskog L, Vand HD, de Jager JP, et al. Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet, 2004, 363(9410): 675-681.
18. Emery P, Breedveld FC, Hall S, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet, 2008, 372(9636): 375-382.
19. Smolen JS, Nash P, Durez P, et al. Maintenance, reduction, or withdrawal of etanercept after treatment with etanercept and methotrexate in patients with moderate rheumatoid arthritis (PRESERVE): a randomised controlled trial. Lancet, 2013, 381(9870): 918-929.
20. 孙艳坤, 刘国恩, 李幼平. 化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤的药物经济学系统评价. 中国循证医学杂志, 2013, 13(6): 700-708.

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Cost-effectiveness analysis of etanercept combined with methotrexate in the treatment of rheumatoid arthritis

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