Limits...
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

Changes over time in the number of patients with BASDAI within a specific interval in two treatment strategies. Strategy 1 consists of five available non-steroidal anti-inflammatory drugs (NSAIDs) and Strategy 2 consists of the same available NSAIDs as in Strategy 1 and two tumour necrosis factor-α antagonists
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Changes over time in the number of patients with BASDAI within a specific interval in two treatment strategies. Strategy 1 consists of five available non-steroidal anti-inflammatory drugs (NSAIDs) and Strategy 2 consists of the same available NSAIDs as in Strategy 1 and two tumour necrosis factor-α antagonists

Mentions: The predicted size of the prevalent AS populations at yearly time points between January 1, 2014 and January 1, 2034 varied within the range of 67,145–69,957, corresponding to a prevalence of approximately 0.4 %. Forty-four to 46 percent of the patients received anti-TNF agents over the period from 2014 to 2034. The numbers of AS patients with low BASDAI in the intervals [0, 2) and [2, 4) were higher in Strategy 2 than in Strategy 1, while those with moderate to high BASDAI in the intervals [4, 6) and [6, 8) were higher in Strategy 1 than in Strategy 2 over time (Fig. 3; the square bracket or the parenthesis at one end of an interval indicates that its adjacent endpoint is included or excluded, respectively). Differences in the number of AS patients with very high BASDAI in the interval [8, 10] were negligible between the two strategies. Inclusion of two anti-TNF agents in the AS treatment (Strategy 2) affects the numbers of AS patients with BASDAI in the intervals [4, 6) and [0, 2] more pronouncedly in the other intervals.Fig. 3


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)

Changes over time in the number of patients with BASDAI within a specific interval in two treatment strategies. Strategy 1 consists of five available non-steroidal anti-inflammatory drugs (NSAIDs) and Strategy 2 consists of the same available NSAIDs as in Strategy 1 and two tumour necrosis factor-α antagonists
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Changes over time in the number of patients with BASDAI within a specific interval in two treatment strategies. Strategy 1 consists of five available non-steroidal anti-inflammatory drugs (NSAIDs) and Strategy 2 consists of the same available NSAIDs as in Strategy 1 and two tumour necrosis factor-α antagonists
Mentions: The predicted size of the prevalent AS populations at yearly time points between January 1, 2014 and January 1, 2034 varied within the range of 67,145–69,957, corresponding to a prevalence of approximately 0.4 %. Forty-four to 46 percent of the patients received anti-TNF agents over the period from 2014 to 2034. The numbers of AS patients with low BASDAI in the intervals [0, 2) and [2, 4) were higher in Strategy 2 than in Strategy 1, while those with moderate to high BASDAI in the intervals [4, 6) and [6, 8) were higher in Strategy 1 than in Strategy 2 over time (Fig. 3; the square bracket or the parenthesis at one end of an interval indicates that its adjacent endpoint is included or excluded, respectively). Differences in the number of AS patients with very high BASDAI in the interval [8, 10] were negligible between the two strategies. Inclusion of two anti-TNF agents in the AS treatment (Strategy 2) affects the numbers of AS patients with BASDAI in the intervals [4, 6) and [0, 2] more pronouncedly in the other intervals.Fig. 3

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