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Impact on total population health and societal cost, and the implication on the actual cost-effectiveness of including tumour necrosis factor-α antagonists in management of ankylosing spondylitis: a dynamic population modelling study.

Tran-Duy A, Boonen A, van de Laar MA, Severens JL - Cost Eff Resour Alloc (2015)

Bottom Line: The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54-205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58-31.21 million Euros) and in annual costs of healthcare categories other than drugs (7.23-11.90 million Euros).Incremental cost (Euros) per QALY gained in Strategy 2 compared to Strategy 1 corresponding to decision time spans of 5, 10, 15 and 20 years improved slightly from 75,379 to 67,268, 63,938 and 61,129, respectively.At willingness-to-pay thresholds of 118,656, 112,067, 110,188 and 110,512 Euros, it was 99 % certain that Strategy 2 was cost-effective for decision time spans of 5, 10, 15 and 20, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands ; Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Background: Sequential treatment of ankylosing spondylitis (AS) that includes tumour necrosis factor-α antagonists (anti-TNF agents) has been applied in most of the Western countries. Existing cost-effectiveness (CE) models almost exclusively presented the incremental CE of anti-TNF agents using a closed cohort while budget impact studies are mainly lacking. Notwithstanding, information on impact on total population health and societal budget as well as on actual incremental CE for a given decision time span are important for decision makers. This study aimed at quantifying, for different decision time spans starting from January 1, 2014 in the Dutch society, (1) impact of sequential drug treatment strategies without and with inclusion of anti-TNF agents (Strategies 1 and 2, respectively) on total population health and societal cost, and (2) the actual incremental CE of Strategy 2 compared to Strategy 1.

Methods: Dynamic population modelling was used to capture total population health and cost, and the actual incremental CE. Distinguishing the prevalent AS population on January 1, 2014 and the incident AS cohorts in the subsequent 20 years, the model tracked individually an actual number of AS patients until death or end of the simulation time. During the simulation, data on patient characteristics, history of drug use, costs and health at discrete time points were generated. In Strategy 1, five nonsteroidal anti-inflammatory drugs (NSAIDs) were available but anti-TNF agents withdrawn. In Strategy 2, five NSAIDs and two anti-TNF agents continued to be available.

Results: The predicted size of the prevalent AS population in the Dutch society varied within the range of 67,145-69,957 with 44-46 % of the patients receiving anti-TNF agents over the period 2014-2034. The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54-205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58-31.21 million Euros) and in annual costs of healthcare categories other than drugs (7.23-11.90 million Euros). Incremental cost (Euros) per QALY gained in Strategy 2 compared to Strategy 1 corresponding to decision time spans of 5, 10, 15 and 20 years improved slightly from 75,379 to 67,268, 63,938 and 61,129, respectively. At willingness-to-pay thresholds of 118,656, 112,067, 110,188 and 110,512 Euros, it was 99 % certain that Strategy 2 was cost-effective for decision time spans of 5, 10, 15 and 20, respectively.

Conclusions: Using the dynamic population approach, the present model can project real-time data to inform a healthcare system decision that affects all actual number of AS patients eligible for anti-TNF agents within different decision time spans. The predicted total population costs of different categories in the present study can help plan the organization of the healthcare resources based on the national budget for the disease.

No MeSH data available.


Related in: MedlinePlus

Main components and simulation process of the patient-level model used for tracking a patient with ankylosing spondylitis. For more information, see Tran-Duy et al. [20]
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Fig1: Main components and simulation process of the patient-level model used for tracking a patient with ankylosing spondylitis. For more information, see Tran-Duy et al. [20]

Mentions: As in Tran-Duy et al. [20], the recommendations for treatment of AS from the Assessment in SpondyloArthritis International Society (ASAS) [9], which in many countries including The Netherlands have been adopted, were used to simulate the decision on starting and switching a drug based on BASDAI and the number of drugs that have been used. In the current prospective simulations, two treatment strategies were compared. In Strategy 1, anti-TNF agent would no longer be available from January 1, 2014 onwards; in Strategy 2, anti-TNF agents continued to be available. For the prevalent AS population on the starting date of the simulation, i.e. January 1, 2014, treatment history had to be simulated as there were no data available for the Dutch AS population on this date. Therefore, we performed two stages of simulation: (1) the burn-in stage in which a historical simulation was executed, starting from January 1, 1996 where data on the prevalent Dutch AS population were available, to obtain characteristics and treatment history of the prevalent population on January 1, 2014, and (2) the main stage in which prospective simulations were executed to quantify the AS population properties over time in different treatment strategies. For the incident cases, we assumed that no patients had received NSAIDs or anti-TNF agents before entering the simulation. Figure 1 conceptualises the main components and simulation process adapted from PLMod for use in the main stage of the current dynamic population model.Fig. 1


Impact on total population health and societal cost, and the implication on the actual cost-effectiveness of including tumour necrosis factor-α antagonists in management of ankylosing spondylitis: a dynamic population modelling study.

Tran-Duy A, Boonen A, van de Laar MA, Severens JL - Cost Eff Resour Alloc (2015)

Main components and simulation process of the patient-level model used for tracking a patient with ankylosing spondylitis. For more information, see Tran-Duy et al. [20]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597433&req=5

Fig1: Main components and simulation process of the patient-level model used for tracking a patient with ankylosing spondylitis. For more information, see Tran-Duy et al. [20]
Mentions: As in Tran-Duy et al. [20], the recommendations for treatment of AS from the Assessment in SpondyloArthritis International Society (ASAS) [9], which in many countries including The Netherlands have been adopted, were used to simulate the decision on starting and switching a drug based on BASDAI and the number of drugs that have been used. In the current prospective simulations, two treatment strategies were compared. In Strategy 1, anti-TNF agent would no longer be available from January 1, 2014 onwards; in Strategy 2, anti-TNF agents continued to be available. For the prevalent AS population on the starting date of the simulation, i.e. January 1, 2014, treatment history had to be simulated as there were no data available for the Dutch AS population on this date. Therefore, we performed two stages of simulation: (1) the burn-in stage in which a historical simulation was executed, starting from January 1, 1996 where data on the prevalent Dutch AS population were available, to obtain characteristics and treatment history of the prevalent population on January 1, 2014, and (2) the main stage in which prospective simulations were executed to quantify the AS population properties over time in different treatment strategies. For the incident cases, we assumed that no patients had received NSAIDs or anti-TNF agents before entering the simulation. Figure 1 conceptualises the main components and simulation process adapted from PLMod for use in the main stage of the current dynamic population model.Fig. 1

Bottom Line: The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54-205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58-31.21 million Euros) and in annual costs of healthcare categories other than drugs (7.23-11.90 million Euros).Incremental cost (Euros) per QALY gained in Strategy 2 compared to Strategy 1 corresponding to decision time spans of 5, 10, 15 and 20 years improved slightly from 75,379 to 67,268, 63,938 and 61,129, respectively.At willingness-to-pay thresholds of 118,656, 112,067, 110,188 and 110,512 Euros, it was 99 % certain that Strategy 2 was cost-effective for decision time spans of 5, 10, 15 and 20, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands ; Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands ; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Background: Sequential treatment of ankylosing spondylitis (AS) that includes tumour necrosis factor-α antagonists (anti-TNF agents) has been applied in most of the Western countries. Existing cost-effectiveness (CE) models almost exclusively presented the incremental CE of anti-TNF agents using a closed cohort while budget impact studies are mainly lacking. Notwithstanding, information on impact on total population health and societal budget as well as on actual incremental CE for a given decision time span are important for decision makers. This study aimed at quantifying, for different decision time spans starting from January 1, 2014 in the Dutch society, (1) impact of sequential drug treatment strategies without and with inclusion of anti-TNF agents (Strategies 1 and 2, respectively) on total population health and societal cost, and (2) the actual incremental CE of Strategy 2 compared to Strategy 1.

Methods: Dynamic population modelling was used to capture total population health and cost, and the actual incremental CE. Distinguishing the prevalent AS population on January 1, 2014 and the incident AS cohorts in the subsequent 20 years, the model tracked individually an actual number of AS patients until death or end of the simulation time. During the simulation, data on patient characteristics, history of drug use, costs and health at discrete time points were generated. In Strategy 1, five nonsteroidal anti-inflammatory drugs (NSAIDs) were available but anti-TNF agents withdrawn. In Strategy 2, five NSAIDs and two anti-TNF agents continued to be available.

Results: The predicted size of the prevalent AS population in the Dutch society varied within the range of 67,145-69,957 with 44-46 % of the patients receiving anti-TNF agents over the period 2014-2034. The use of anti-TNF agents resulted in an increase in the annual drug costs (168.54-205.28 million Euros), but at the same time caused a decrease in the annual productivity costs (12.58-31.21 million Euros) and in annual costs of healthcare categories other than drugs (7.23-11.90 million Euros). Incremental cost (Euros) per QALY gained in Strategy 2 compared to Strategy 1 corresponding to decision time spans of 5, 10, 15 and 20 years improved slightly from 75,379 to 67,268, 63,938 and 61,129, respectively. At willingness-to-pay thresholds of 118,656, 112,067, 110,188 and 110,512 Euros, it was 99 % certain that Strategy 2 was cost-effective for decision time spans of 5, 10, 15 and 20, respectively.

Conclusions: Using the dynamic population approach, the present model can project real-time data to inform a healthcare system decision that affects all actual number of AS patients eligible for anti-TNF agents within different decision time spans. The predicted total population costs of different categories in the present study can help plan the organization of the healthcare resources based on the national budget for the disease.

No MeSH data available.


Related in: MedlinePlus