피하주사로 투여하는 생물학적 항류마티스 제제의 비용 최소화 연구
Cost-Minimization Analysis of Biologic Disease-Modifying Antirheumatic Drugs Administered by Subcutaneous Injections in Patients with Rheumatoid Arthritis
0
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. Methods: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. Results: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. Conclusion: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.
Abstract
Background: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. Methods: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. Results: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. Conclusion: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.
참고문헌 (45)
- "Handout on Health: Rheumatoid Arthritis, August 2014" (2014)[URL]
- 박남규, "두 지역사회에서 골관절염 및 류마티스 관절염의 유병률", 대한류마티스학회지, 10(2), pp.7~157 (2003), 대한류마티스학회
- 허남욱, "국민건강영양조사를 이용한 한국인 관절염의 유병률 현황과 연도별 변화", 대한류마티스학회지, 15(1), pp.11~26 (2008), 대한류마티스학회
- 최효진, "만성질환 관리사업 보건지표 조사 결과를 이용한 인천 지역의 근골격계 및 류마티스 질환의 유병률 및 특성", 대한류마티스학회지, 16(4), pp.281~290 (2009), 대한류마티스학회
- "Disease/Service medical statistics M05, M06"[URL]
- Singh JA, "2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis", Arthritis Rheumatol, 68(1), pp.1~26 (2016)
- Smolen JS, "EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update", Ann Rheum Dis, 73(3), pp.492~509 (2014)
- Weinblatt ME, "Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate:the ARMADA trial", Arthritis Rheum, 48(1), pp.35~45 (2003)
- Moreland LW, "Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein", N Engl J Med, 337(3), pp.141~147 (1997)
- Kremer J, "Golimumab, a new human anti-tumor necrosis factor alpha antibody, administered intravenously in patients with active rheumatoid arthritis: Forty-eight-week efficacy and safety results of a phase III randomized, double-blind, placebocontrolled study", Arthritis Rheum, 62(4), pp.917~928 (2010)
- Maini R, "Infliximab (chimeric antitumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group", Lancet, 354(9194), pp.1932~1939 (1999)
- Kremer JM, "Treatment of rheumatoid arthritis by selective inhibition of T-cell activation with fusion protein CTLA4Ig", N Engl J Med, 349(20), pp.1907~1915 (2003)
- Smolen JS, "Effect of interleukin-6receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial", Lancet, 371(9617), pp.987~997 (2008)
- Burmester GR, "A randomised, double-blind, parallel-group study of the safety and efficacy of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with moderate to severe rheumatoid arthritis (SUMMACTA study)", Ann Rheum Dis, 73(1), pp.69~74 (2014)
- Iwahashi M, "Efficacy, safety, pharmacokinetics and immunogenicity of abatacept administered subcutaneously or intravenously in Japanese patients with rheumatoid arthritis and inadequate response to methotrexate: a Phase II", III, randomized study, 2014, pp.24(6), 885~891
- Huynh TK, "Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis", Patient Prefer Adherence, 8, pp.93~99 (2014)
- Sylwestrzak G, "Considering patient preferences when selecting anti-tumor necrosis factor therapeutic options", Am Health Drug Benefits, 7(2), pp.71~81 (2014)
- Keystone E, "Subcutaneous abatacept in rheumatoid arthritis: current update", Expert Opin Biol Ther, 15(8), pp.1221~1230 (2015)
- Chilton F, "Treatment choices, preferences and decisionmaking by patients with rheumatoid arthritis", Musculoskeletal Care, 6(1), pp.1~14 (2008)
- McLaughlin M, "Safety of subcutaneous versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis", Expert Opin Drug Saf, 14(3), pp.429~437 (2015)
- Román Ivorra JA, "Cost analysis of biologic drugs in rheumatoid arthritis first line treatment after methotrexate failure according to patients' body weight", Reumatol Clin (2015)
- Jin JF, "The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection", Patient Prefer Adherence, 9, pp.923~942 (2015)
- Buckley F, "Comparative Efficacy of Novel DMARDs as Monotherapy and in Combination with Methotrexate in Rheumatoid Arthritis Patients with Inadequate Response to Conventional DMARDs: A Network Meta-Analysis", J Manag Care Spec Pharm, 21(5), pp.409~423 (2015)
- Aaltonen KJ, "Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis", PLoS One, 7(1), pp.e30275~ (2012)
- Gallego-Galisteo M, "Indirect comparison of biological treatments in refractory rheumatoid arthritis", J Clin Pharm Ther, 37(3), pp.301~307 (2012)
- Park SJ, "Medical cost analysis of TNF antagonist in patients with rheumatoid arthritis using national health insurance claim data", M.S., Clinical pharmacy, pp.2011
- "National Physical Fitness Survey:Weight of adult in 2013"[URL]
- Du Pan SM, "Comparison of drug retention rates and causes of drug discontinuation between anti-tumor necrosis factor agents in rheumatoid arthritis", Arthritis Rheum, 61(5), pp.560~568 (2009)
- Sokka T, "Mortality in rheumatoid arthritis: 2008update", Clin Exp Rheumatol, 26(5 Suppl 51), pp.S35~S61 (2008)
- "Complete Life Table 2014"[URL]
- "Drug weighted average price in 2014"[URL]
- "Drug reimbursement list and listed drug price"[URL]
- "Drug Information"[URL]
- "Korean Medical Service Fee"[URL]
- Gomez-Reino, "Post-Hoc Analysis Of Serious Infection Events and Selected Clinical Factors In Rheumatoid Arthritis Patients Treated With Tofacitinib", Poster presented at the ACR, 2013, ~
- "National Health Insurance Statistical Yearbook 2013"[URL]
- "Consumer Price Index in Health Care"[URL]
- "Survey on National Health Insurance in 2013"[URL]
- Wolfe F, "The long-term outcomes of rheumatoid arthritis:a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis", Arthritis Rheum, 41(6), pp.1072~1082 (1998)
- Lee TJ, "Cost of illness and quality of life of patients with rheumatoid arthritis in South Korea", Value Health, 15(1 Suppl), pp.S43~S49 (2012)
- Briggs A, "Decision Modelling for Health Economic Evaluation", pp.108~ (2006), Oxford University Press
- Fragoulakis V, "Economic evaluation of anti-TNF agents for patients with rheumatoid arthritis in Greece", Clinicoecon Outcomes Res, 7, pp.85~93 (2015)
- Bonafede MM, "Cost per treated patient for etanercept, adalimumab, and infliximab across adult indications: a claims analysis", Adv Ther, 29(3), pp.234~248 (2012)
- Schabert VF, "Costs of tumor necrosis factor blockers per treated patient using real-world drug data in a managed care population", J Manag Care Pharm, 19(8), pp.621~630 (2013)
- Ariza R, "Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain", Farm Hosp, 38(4), pp.257~265 (2014)