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First-Line Etanercept With MTX Increased Cost-Effectiveness Ratio by $88,815 per QALY
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Compared with second-line etanercept, a first-line combination therapy of etanercept with methotrexate cost $88,815 more per quality-adjusted life year gained when researchers used an incremental cost-effective ratio, according to a 5-year cost-effectiveness analysis of patients with juvenile arthritis.
Nadia J. Luca, MD, assistant professor in the Department of Medicine at the University of Calgary, and colleagues compared etanercept as a first-line therapy with methotrexate (MTX) to MTX followed by etanercept as a second-line therapy among a 5-year cohort of patients who were newly diagnosed with juvenile idiopathic arthritis (JIA). The researchers used a state-transition model based on the Canadian health care system and excluded patients younger than 11 years, patients who weighed less than 40 kg or who had less than five active joints. The researchers calculated quality-adjusted life year (QALY) and direct costs, while discounting by 3% per year.
The researchers found first-line therapy had a higher discounted incremental cost by $16,893 and more QALYs gained by 0.19. The cost-effectiveness ratio for first-line therapy was therefore $88,815 per QALY. According to the researchers, the results were sensitive to etanercept cost, the model’s time horizon and the estimated efficacy of first-line therapies. For severe JIA, the cost-effectiveness ratio was $33,960 per QALY. – by Will Offit
Disclosure: Luca reports no relevant financial disclosures. Please see the full study for a list of all other relevant financial disclosures.
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