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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2.	蘇妍, 徐高四, 涂衛平, 等. 英夫利西單抗聯合甲氨蝶呤治療類風濕性關節炎的 Meta 分析. 實用醫學雜志, 2014, 33(13): 2142-2147.
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4.	楊喜梅, 竇存瑞, 魏花萍. 阿達木單抗治療對緩解抗風濕性藥物無效的類風濕性關節炎的系統評價. 中國循證醫學雜志, 2011, 11(1): 84-90.
5.	劉一, 劉恩溢, 黃琳, 等. 鹿瓜多肽注射液治療類風濕性關節炎療效及安全性的 Meta 分析. 中國藥房, 2012, 23(20): 1890-1893.
6.	中華醫學會風濕病學分會. 類風濕關節炎診斷及治療指南. 中華風濕病學雜志, 2010, 14(4): 265-270.
7.	李向蓮, 沈建通, 李幼平, 等. 膠囊內鏡診斷小腸疾病的衛生技術評估. 中國循證醫學雜志, 2014, 14(5): 541-553.
8.	鐘黛云, 劉愛軍, 駱楚君, 等. 射頻消融術與胺碘酮比較治療房顫的藥物經濟學評價. 中國循證醫學雜志, 2015, 15(9): 1018-1023.
9.	劉國恩, 主編. 中國藥物經濟學評價指南及導讀: 2015版. 北京: 科學出版社, 2015: 31-33.
10.	劉強, 李洪超, 馬愛霞. 基于決策樹模型對我國中重度抑郁癥臨床常用藥物治療方案選擇的成本效果分析. 中國循證醫學雜志, 2016, 16(6): 628-634.
11.	李鶴, 夏蘇建. 類風濕性關節炎患者醫療費用影響因素研究. 中國病案, 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.	劉國恩, 張玉哲, 范麗亞, 等. 急性缺血性腦卒中三種常用神經保護藥物成本-效果分析. 中國衛生經濟, 2012, 31(8): 62-65.
14.	Cochrane handbook for systematic reviews of interventions version 5. 3. Available at: htttp:www.cochranehandbook.org.
15.	陳群飛, 王莉, 李幼平, 等. γ-干擾素釋放試驗篩查潛伏性結核患者的成本效果分析. 中國循證醫學雜志, 2011, 11(7): 768-774.
16.	劉國恩, 主編. 中國藥物經濟學評價指南及導讀: 2015版. 北京: 科學出版社, 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.	孫艷坤, 劉國恩, 李幼平. 化療與利妥昔單抗聯用治療非霍奇金淋巴瘤的藥物經濟學系統評價. 中國循證醫學雜志, 2013, 13(6): 700-708.

1. 國際ACR小組委員會. 類風濕性關節炎的治療指南. 繼續醫學教育, 2005, 19(3): 67-73.
2. 蘇妍, 徐高四, 涂衛平, 等. 英夫利西單抗聯合甲氨蝶呤治療類風濕性關節炎的 Meta 分析. 實用醫學雜志, 2014, 33(13): 2142-2147.
3. 李瑞, 孟慶剛. 類風濕性關節炎的臨床治療研究. 中華中醫藥學刊, 2007, 25(7): 1348-1352.
4. 楊喜梅, 竇存瑞, 魏花萍. 阿達木單抗治療對緩解抗風濕性藥物無效的類風濕性關節炎的系統評價. 中國循證醫學雜志, 2011, 11(1): 84-90.
5. 劉一, 劉恩溢, 黃琳, 等. 鹿瓜多肽注射液治療類風濕性關節炎療效及安全性的 Meta 分析. 中國藥房, 2012, 23(20): 1890-1893.
6. 中華醫學會風濕病學分會. 類風濕關節炎診斷及治療指南. 中華風濕病學雜志, 2010, 14(4): 265-270.
7. 李向蓮, 沈建通, 李幼平, 等. 膠囊內鏡診斷小腸疾病的衛生技術評估. 中國循證醫學雜志, 2014, 14(5): 541-553.
8. 鐘黛云, 劉愛軍, 駱楚君, 等. 射頻消融術與胺碘酮比較治療房顫的藥物經濟學評價. 中國循證醫學雜志, 2015, 15(9): 1018-1023.
9. 劉國恩, 主編. 中國藥物經濟學評價指南及導讀: 2015版. 北京: 科學出版社, 2015: 31-33.
10. 劉強, 李洪超, 馬愛霞. 基于決策樹模型對我國中重度抑郁癥臨床常用藥物治療方案選擇的成本效果分析. 中國循證醫學雜志, 2016, 16(6): 628-634.
11. 李鶴, 夏蘇建. 類風濕性關節炎患者醫療費用影響因素研究. 中國病案, 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. 劉國恩, 張玉哲, 范麗亞, 等. 急性缺血性腦卒中三種常用神經保護藥物成本-效果分析. 中國衛生經濟, 2012, 31(8): 62-65.
14. Cochrane handbook for systematic reviews of interventions version 5. 3. Available at: htttp:www.cochranehandbook.org.
15. 陳群飛, 王莉, 李幼平, 等. γ-干擾素釋放試驗篩查潛伏性結核患者的成本效果分析. 中國循證醫學雜志, 2011, 11(7): 768-774.
16. 劉國恩, 主編. 中國藥物經濟學評價指南及導讀: 2015版. 北京: 科學出版社, 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. 孫艷坤, 劉國恩, 李幼平. 化療與利妥昔單抗聯用治療非霍奇金淋巴瘤的藥物經濟學系統評價. 中國循證醫學雜志, 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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