PMID- 28202743
OWN - NLM
STAT- MEDLINE
DCOM- 20180423
LR  - 20181202
IS  - 1499-2752 (Electronic)
IS  - 0315-162X (Linking)
VI  - 44
IP  - 7
DP  - 2017 Jul
TI  - The Cost-effectiveness of Sequences of Biological Disease-modifying Antirheumatic 
      Drug Treatment in England for Patients with Rheumatoid Arthritis Who Can Tolerate 
      Methotrexate.
PG  - 973-980
LID - 10.3899/jrheum.160941 [doi]
AB  - OBJECTIVE: To ascertain whether strategies of treatment with a biological 
      disease-modifying antirheumatic drug (bDMARD) are cost-effective in an English 
      setting. Results are presented for those patients with moderate to severe 
      rheumatoid arthritis (RA) and those with severe RA. METHODS: An economic model to 
      assess the cost-effectiveness of 7 bDMARD was developed. A systematic literature 
      review and network metaanalysis was undertaken to establish relative clinical 
      effectiveness. The results were used to populate the model, together with 
      estimates of Health Assessment Questionnaire (HAQ) score following European 
      League Against Rheumatism response; annual costs, and utility, per HAQ band; 
      trajectory of HAQ for patients taking bDMARD; and trajectory of HAQ for patients 
      using nonbiologic therapy (NBT). Results were presented as those associated with 
      the strategy with the median cost-effectiveness. Supplementary analyses were 
      undertaken assessing the change in cost-effectiveness when only patients with the 
      most severe prognoses taking NBT were provided with bDMARD treatment. The costs 
      per quality-adjusted life-year (QALY) values were compared with reported 
      thresholds from the UK National Institute for Health and Care Excellence of 
       pound20,000 to  pound30,000 (US$24,700 to US$37,000). RESULTS: In the primary analyses, 
      the cost per QALY of a bDMARD strategy was  pound41,600 for patients with severe RA 
      and  pound51,100 for those with moderate to severe RA. Under the supplementary 
      analyses, the cost per QALY fell to  pound25,300 for those with severe RA and to 
       pound28,500 for those with moderate to severe RA. CONCLUSION: The cost-effectiveness 
      of bDMARD in RA in England is questionable and only meets current accepted levels 
      in subsets of patients with the worst prognoses.
FAU - Stevenson, Matt D
AU  - Stevenson MD
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK. m.d.stevenson@shef.ac.uk.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust. m.d.stevenson@shef.ac.uk.
FAU - Wailoo, Allan J
AU  - Wailoo AJ
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Tosh, Jonathan C
AU  - Tosh JC
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Hernandez-Alava, Monica
AU  - Hernandez-Alava M
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Gibson, Laura A
AU  - Gibson LA
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Stevens, John W
AU  - Stevens JW
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Archer, Rachel J
AU  - Archer RJ
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Simpson, Emma L
AU  - Simpson EL
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Hock, Emma S
AU  - Hock ES
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Young, Adam
AU  - Young A
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
FAU - Scott, David L
AU  - Scott DL
AD  - From the School of Health and Related Research, University of Sheffield, 
      Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National 
      Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's 
      College Hospital NHS Foundation Trust, London, UK.
AD  - M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health 
      and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of 
      Health Economics, School of Health and Related Research, University of Sheffield; 
      J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related 
      Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research 
      Fellow in Econometrics, School of Health and Related Research, University of 
      Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health 
      and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in 
      Decision Science, School of Health and Related Research, University of Sheffield; 
      R.J. Archer, PhD, Research Fellow, School of Health and Related Research, 
      University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and 
      Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, 
      School of Health and Related Research, University of Sheffield; A. Young, FRCP, 
      Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness 
      Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of 
      Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS 
      Foundation Trust.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170215
PL  - Canada
TA  - J Rheumatol
JT  - The Journal of rheumatology
JID - 7501984
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Products)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
CIN - J Rheumatol. 2017 Jul;44(7):965-967. PMID: 28668812
MH  - Antirheumatic Agents/*economics/therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy/economics
MH  - Biological Products/*economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - England
MH  - Humans
MH  - Methotrexate/*economics/therapeutic use
OTO - NOTNLM
OT  - ANTIRHEUMATIC AGENTS
OT  - COST-BENEFIT ANALYSIS
OT  - MEDICAL ECONOMICS
OT  - RHEUMATOID ARTHRITIS
EDAT- 2017/02/17 06:00
MHDA- 2018/04/24 06:00
CRDT- 2017/02/17 06:00
PHST- 2016/12/16 00:00 [accepted]
PHST- 2017/02/17 06:00 [pubmed]
PHST- 2018/04/24 06:00 [medline]
PHST- 2017/02/17 06:00 [entrez]
AID - jrheum.160941 [pii]
AID - 10.3899/jrheum.160941 [doi]
PST - ppublish
SO  - J Rheumatol. 2017 Jul;44(7):973-980. doi: 10.3899/jrheum.160941. Epub 2017 Feb 
      15.