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Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

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  • Benjamin Birkner
  • Jürgen Rech
  • Tom Stargardt

Abstract

Objective: Recent guideline updates have suggested de-escalating DMARDs when patients with rheumatoid arthritis achieve remission or low disease activity. We aim to evaluate whether it is cost-effective to de-escalate the biological form of DMARDs (bDMARDs). Methods: Using a Markov model, we performed a cost-utility analysis for RA patients on bDMARD treatment. We compared continuing treatment (standard care) to a tapering approach (i.e., an immediate 50% dose reduction), withdrawal (i.e., an immediate 100% dose reduction) and tapering followed by withdrawal of bDMARDs. The parametrization is based on a comprehensive literature review. Results were computed for 30 years with a cycle length of three months. We applied the payer’s perspective for Germany and conducted deterministic and probabilistic sensitivity analyses. Results: Tapering or withdrawing bDMARD treatment resulted in ICERs of €526,254 (incr. costs -78,845, incr. QALYs -0.1498) or €216,879 (incr. costs -€121,691, incr. QALYs -0.5611) compared to standard care. Tapering followed by withdrawal resulted in a loss of 0.4354 QALYs and savings of €107,969 per patient, with an ICER of €247,987. Deterministic sensitivity analysis revealed that our results remained largely unaffected by parameter changes. Probabilistic sensitivity analysis suggests that tapering, withdrawal and tapering followed by withdrawal were dominant in 39.8%, 28.2% and 29.0% of 10,000 iterations. Conclusion: Our findings suggest that de-escalating bDMARDs in patients with RA may result in high cost savings but also a decrease in quality of life compared to standard care. If decision makers choose to implement de-escalation in daily practice, our results suggest the tapering approach.

Suggested Citation

  • Benjamin Birkner & Jürgen Rech & Tom Stargardt, 2020. "Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-17, January.
    • Handle: RePEc:plo:pone00:0226754
    DOI: 10.1371/journal.pone.0226754
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    References listed on IDEAS

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    1. J. Lundkvist & F. Kastäng & G. Kobelt, 2008. "The burden of rheumatoid arthritis and access to treatment: health burden and costs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 49-60, January.
    2. J. Lundqvist & F. Kastäng & G. Kobelt & B. Jönsson, 2008. "The burden of rheumatoid arthritis and access to treatment: determinants of access," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 87-93, January.
    3. J. Smolen & D. Aletaha, 2008. "The burden of rheumatoid arthritis and access to treatment: a medical overview," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 39-47, January.
    4. B. Jönsson & G. Kobelt & J. Smolen, 2008. "The burden of rheumatoid arthritis and access to treatment: uptake of new therapies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 61-86, January.
    5. G. Kobelt & B. Jönsson, 2008. "The burden of rheumatoid arthritis and access to treatment: outcome and cost-utility of treatments," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 95-106, January.
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