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The value of persistence in treatment with subcutaneous TNF-alpha inhibitors for ankylosing spondylitis

Author

Listed:
  • Axel Svedbom

    (ICON Clinical Research)

  • Johan Dalén

    (ICON Clinical Research)

  • Moa Ivergård

    (ICON Clinical Research)

  • Rebekah H. Borse

    (Merck & Co., Inc.)

  • Christopher M. Black

    (Merck & Co., Inc.)

  • Karin Luttropp

    (ICON Clinical Research)

  • Sumesh Kachroo

    (Merck & Co., Inc.)

Abstract

Objective To estimate the impact of persistence on cost-effectiveness of subcutaneous tumor necrosis factor-α inhibitors (SC-TNFis) from healthcare and societal perspectives in a United Kingdom ankylosing spondylitis (AS) population using a recently published Markov cohort model. Methods A recently published cost-effectiveness model developed for a National Institute for health and Care Excellence appraisal was extended to fit the current study; in brief, it is a Markov cohort model where treatment responders continue from the trial period with maintenance SC-TNFi treatment, while non-responders transition to conventional care. Costs and effects were modeled for a hypothetical SC-TNFi with average efficacy and price. Model outcomes included quality-adjusted life-years (QALYs), total direct and indirect lifetime costs, and incremental cost-effectiveness ratios (ICERs). The cost-effectiveness of SC-TNFi persistence was estimated by decreasing the annual discontinuation probability in five percentage point increments from 25 to 5% per annum. Results From a health care perspective, the ICERs for the modeled discontinuation rates compared to the baseline annual discontinuation rate (25%) ranged between GBP 17,277 and GBP 18,161. From a societal perspective, increased discontinuation rates resulted in decreased total costs and higher QALYs; hence, lower discontinuation rates dominated higher discontinuation rates from a societal perspective. Conclusion In conclusion, this study shows that, all else equal, higher SC-TNFi treatment persistence in AS is cost effective from a health care perspective and dominant from a societal perspective. Hence, all else equal, prescribing the SC-TNFi with the highest persistence may be considered a cost-effective strategy.

Suggested Citation

  • Axel Svedbom & Johan Dalén & Moa Ivergård & Rebekah H. Borse & Christopher M. Black & Karin Luttropp & Sumesh Kachroo, 2020. "The value of persistence in treatment with subcutaneous TNF-alpha inhibitors for ankylosing spondylitis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 45-54, February.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:1:d:10.1007_s10198-019-01110-w
    DOI: 10.1007/s10198-019-01110-w
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    References listed on IDEAS

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    1. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    2. Roxanne Cooksey & Muhammad J Husain & Sinead Brophy & Helen Davies & Muhammad A Rahman & Mark D Atkinson & Ceri J Phillips & Stefan Siebert, 2015. "The Cost of Ankylosing Spondylitis in the UK Using Linked Routine and Patient-Reported Survey Data," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-17, July.
    3. Koopmanschap, Marc A. & Rutten, Frans F. H. & van Ineveld, B. Martin & van Roijen, Leona, 1995. "The friction cost method for measuring indirect costs of disease," Journal of Health Economics, Elsevier, vol. 14(2), pages 171-189, June.
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    More about this item

    Keywords

    Cost–benefit analysis; Medication persistence; Economic evaluation; Ankylosing spondylitis; Bechterew’s disease;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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