Cost-effectiveness of biological therapy compared with methotrexate in the treatment for rheumatoid arthritis in Colombi
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ORIGINAL ARTICLE
Cost-effectiveness of biological therapy compared with methotrexate in the treatment for rheumatoid arthritis in Colombia Carolina Valle-Mercado • Maria-Fernanda Cubides Monica Parra-Torrado • Diego Rosselli
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Received: 8 September 2012 / Accepted: 16 July 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract The objectives of the study are to develop a cost-effectiveness model comparing biological therapy (BT) with methotrexate (MTX) alone, in the treatment for rheumatoid arthritis (RA), combining clinical and qualityof-life data from international trials with local costs and local epidemiological data. We designed a six-month cycle Markov model with five functional states, based on Health Assessment Questionnaire, with patients initiating treatment in any of the predefined states, based on a sample of 150 local RA patients. Simulations ran for 10 and 20 years, and for the whole life span. Utilities, in quality-adjusted life years (QALY), were taken from international literature. Discount rate was 3 % for costs and utilities. We calculated direct and indirect costs using a combination of international and local data. Results are presented as incremental cost-effectiveness ratios (ICER). ICERs in euros per QALY were €143,072 for 10 years; €139,332 for 20 years;
C. Valle-Mercado Faculty of Economics, Universidad de los Andes, Bogota´, Colombia e-mail: [email protected] M.-F. Cubides Rheumatology and Clinical Immunology, Hospital Militar, Universidad de La Sabana, Bogota´, Colombia e-mail: [email protected] M. Parra-Torrado Fedesarrollo, Bogota´, Colombia e-mail: [email protected] D. Rosselli (&) Clinical Epidemiology and Biostatistics Department, Medical School, Pontificia Universidad Javeriana, Carrera 7 No. 40-62, Bogota´, DC, Colombia e-mail: [email protected]
and €137,712 for the whole life span. Total costs with MTX were lower than with BT, despite higher out of pocket, productivity, and complication costs. Under conventional thresholds, and for the ‘‘average’’ RA patient, BT would not be cost-effective in Colombia. BT compared to MTX provides more QALYs, but at a high cost. When ICERs were estimated for Colombia, BT would not be cost-effective. We propose different thresholds for different conditions, perhaps prioritizing chronic diseases that lead to disability. Keywords Rheumatoid arthritis Costeffectiveness analysis Biological therapy QALY Colombia
Introduction Biological therapy (BT) has changed the natural history of rheumatoid arthritis (RA) and has impacted the budget assigned to its treatment [1, 2]. The economic question that arises is if the greater efficacy justifies its higher costs [3–5]. Rheumatoid arthritis, and specifically BT, has been the subject of numerous economic analysis, most of them in developed countries [6, 7]. It has been widely accepted that economic evaluations are not easily generalizable [8]. The case is even more evident when results from developed countries are applied in developing countries where indirect costs, represen
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