ArticleAnnals of the rheumatic diseases2006
Markov model into the cost-utility over five years of etanercept and infliximab compared with usual care in patients with active ankylosing spondylitis.
Article in Annals of the rheumatic diseases, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs.The European journal of health economics : HEPAC : health economics in prevention and care · 2016Pooled it
- Cost effectiveness of therapeutic interventions in ankylosing spondylitis: a critical and systematic review.PharmacoEconomics · 2012Pooled it
- Analysis of Cost-Effectiveness of Biologic Therapies in Axial Spondyloarthritis Based on Real-World Data.ClinicoEconomics and outcomes research : CEOR · 2025Article
- Molecular mechanisms and clinical studies of iguratimod for the treatment of ankylosing spondylitis.Clinical rheumatology · 2021Review
- Cost-Effectiveness of Treatment Strategies with Biologics in Accordance with Treatment Guidelines for Ankylosing Spondylitis: A Patient-Level Model.Journal of managed care & specialty pharmacy · 2020Article
- Predictors of response and drug survival in ankylosing spondylitis patients treated with infliximab.BMC musculoskeletal disorders · 2015Article
- Economic considerations of the treatment of ankylosing spondylitis.The American journal of the medical sciences · 2012Review
- Etanercept in the treatment of recalcitrant enteropathic arthritis: a case report.Journal of medical case reports · 2012Article
- Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway.International journal of rheumatology · 2011Article
- Cost effectiveness of etoricoxib versus celecoxib and non-selective NSAIDS in the treatment of ankylosing spondylitis.PharmacoEconomics · 2010Article
- Variables related to utility in patients with ankylosing spondylitis.Clinical rheumatology · 2009Article
- Etanercept: a review of its use in the management of ankylosing spondylitis and psoriatic arthritis.Drugs · 2007Review
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the incremental cost-utility of etanercept and infliximab compared with usual care in active ankylosing spondylitis.
methodsA Markov model over five years with cycle times of three months was computed. Patients included all had active disease, defined as Bath ankylosing spondylitis disease activity index (BASDAI) >or=4 and could reach low disease activity, defined as BASDAI <4. Non-response to tumour necrosis factor alpha (TNFalpha) inhibitors was always followed by cessation of treatment. Response to TNFalpha inhibitors could be followed at any time by either relapse to BASDAI >or=4, leading to cessation of treatment, or toxicity, leading to cessation of treatment if major. Probabilities for efficacy, relapse, and toxicity were derived from two European randomised controlled trials. Utilities and costs assigned to the BASDAI disease states were derived from a two year observational Dutch cohort. In sensitivity analyses probabilities of effectiveness, toxicity, costs, and utilities were varied.
resultsOver five years the total quality adjusted life years varied from 2.57 to 2.89 for usual care, compared with 3.13 to 3.42 and 3.07 to 3.35 for etanercept or infliximab. Cumulative costs were between 49,555 to 69,982 for usual care compared with 59,574 to 91,183 or 28,3330 to 106,775 for etanercept and infliximab. This resulted in incremental cost-utility ratios varying between 42,914 and 123,761 per QALY for etanercept compared with usual care and 67,207 to 237,010 for infliximab. The model was sensitive to drug prices.
conclusionEtanercept and infliximab have large clinical effects in ankylosing spondylitis. The present model suggests the high drug costs restricts efficient use in all patients who have a BASDAI >4. The validity of the model is limited by insufficient insight in the natural course of the disease and long term effectiveness and toxicity of TNFalpha inhibitors.
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