Current study proves cost-effectiveness of etanercept
02.03.2010 15:40
Health economic aspects of rheumatological diseases
In patients with rheumatoid arthritis (RA), the combination therapy of methotrexate (MTX) and the TNF-a receptor etanercept (Enbrel®) is economical compared to MTX monotherapy. This is proven by the results of the first cost-effectiveness analysis1 on the use of biologics in the treatment of rheumatoid arthritis, which was carried out as a cooperation between the rheumatism unit at the LMU Munich Hospital, Wyeth Pharma, a company of the Pfizer Group, Münster, and InForMed, Ingolstadt , was carried out. The incremental cost-benefit ratio (IKNR) for etanercept determined on the basis of the TEMPO study2 is 38,700 euros per quality-adjusted life year (QALY).
This means that the TNF-a receptor is below the accepted value for Europe for the cost-effectiveness of a therapy option of 50,000 euros per QALY. At a press event that took place in Hamburg on February 2, 2010, the experts emphasized that, in addition to the good effectiveness, there are also economic aspects in favor of the combination therapy of MTX and etanercept for RA patients. In Germany, up to 540,000 adults are affected by rheumatoid arthritis (RA). The progressive disease causes total annual costs of around twelve billion euros, a significant proportion of which are indirect costs such as inability to work.
Biologics such as the TNF-a receptor etanercept (Enbrel®) have been available for therapy for several years. Etanercept, particularly in combination with MTX, has been proven by extensive studies to provide clinical, functional and radiological remission in RA. Now the goal of remission under therapy with etanercept and methotrexate has also been examined from a health economic perspective.
QALY – years full of life
In the current health economic evaluation of TNF-a therapy for the treatment of RA for the German healthcare system, the cost-effectiveness of therapy with etanercept was examined and determined using a Markov model. The basis of the investigation was the TEMPO study, which demonstrated the superiority of the combination of etanercept and methotrexate (MTX) in the treatment of RA compared to monotherapy with MTX. The benefit of the therapy was recorded in the study using quality adjusted life years (QALYs). QALYs are an internationally recognized instrument for mapping patient-relevant effects and assess life extension and quality of life together. “It is based on the assumption that a year of good health has a higher value than a year of life in which the person affected is limited by illness,” explained Dr. Thomas Mittendorf, managing partner of Herescon GmbH, Hanover.
“The target parameters for the cost-effectiveness of etanercept therapy were the incremental cost-effectiveness ratio (IKWR) and the incremental cost-effectiveness ratio (IKNR),” said Professor Dr. Hendrik Schulze-Koops, head of the rheumatism unit at the Ludwig Maximilians University Hospital, Munich, in the run-up to the event. The incremental costs of the combination therapy (additional costs to MTX monotherapy) are set in relation to each year gained in remission (according to the DAS28 definition) or each QALY.
Sensible investment in healthcare
The incremental cost-effectiveness ratio of the combination therapy compared to MTX monotherapy was 21,300 euros per year in remission. The incremental cost-benefit ratio is 38,700 euros per quality-adjusted life year. This IKNR value is below the accepted value for Europe for the cost-effectiveness of a therapy option of 50,000 euros per QALY. “Both the IKNR and the IKWR value suggest that investing appropriate resources in the healthcare system at reasonable costs can enable a large proportion of those affected to improve their quality of life and makes sense given the high economic burden of disease,” says Schulze -Koops in an interview.