PubTransformer

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PMID- 28554192
OWN - NLM
STAT- MEDLINE
DA  - 20170529
DCOM- 20170711
LR  - 20170713
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Linking)
VI  - 167
IP  - 1
DP  - 2017 Jul 04
TI  - Triple Therapy Versus Biologic Therapy for Active Rheumatoid Arthritis: A
      Cost-Effectiveness Analysis.
PG  - 8-16
LID - 10.7326/M16-0713 [doi]
AB  - Background: The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial
      found triple therapy to be noninferior to etanercept-methotrexate in patients
      with active rheumatoid arthritis (RA). Objective: To determine the
      cost-effectiveness of etanercept-methotrexate versus triple therapy as a
      first-line strategy. Design: A within-trial analysis based on the 353
      participants in the RACAT trial and a lifetime analysis that extrapolated costs
      and outcomes by using a decision analytic cohort model. Data Sources: The RACAT
      trial and sources from the literature. Target Population: Patients with active RA
      despite at least 12 weeks of methotrexate therapy. Time Horizon: 24 weeks and
      lifetime. Perspective: Societal and Medicare. Intervention:
      Etanercept-methotrexate first versus triple therapy first. Outcome Measures:
      Incremental costs, quality-adjusted life-years (QALYs), and incremental
      cost-effectiveness ratios (ICERs). Results of Base-Case Analysis: The
      within-trial analysis found that etanercept-methotrexate as first-line therapy
      provided marginally more QALYs but accumulated substantially higher drug costs.
      Differences in other costs between strategies were negligible. The ICERs for
      first-line etanercept-methotrexate and triple therapy were $2.7 million per QALY 
      and $0.98 million per QALY over 24 and 48 weeks, respectively. The lifetime
      analysis suggested that first-line etanercept-methotrexate would result in 0.15
      additional lifetime QALY, but this gain would cost an incremental $77 290,
      leading to an ICER of $521 520 per QALY per patient. Results of Sensitivity
      Analysis: Considering a long-term perspective, an initial strategy of
      etanercept-methotrexate and biologics with similar cost and efficacy is unlikely 
      to be cost-effective compared with using triple therapy first, even under
      optimistic assumptions. Limitation: Data on the long-term benefit of triple
      therapy are uncertain. Conclusion: Initiating biologic therapy without trying
      triple therapy first increases costs while providing minimal incremental benefit.
      Primary Funding Source: The Cooperative Studies Program, Department of Veterans
      Affairs Office of Research and Development, Canadian Institutes for Health
      Research, and an interagency agreement with the National Institutes of
      Health-American Recovery and Reinvestment Act.
FAU - Bansback, Nick
AU  - Bansback N
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Phibbs, Ciaran S
AU  - Phibbs CS
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Sun, Huiying
AU  - Sun H
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - O'Dell, James R
AU  - O'Dell JR
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Brophy, Mary
AU  - Brophy M
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Keystone, Edward C
AU  - Keystone EC
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Leatherman, Sarah
AU  - Leatherman S
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Mikuls, Ted R
AU  - Mikuls TR
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
FAU - Anis, Aslam H
AU  - Anis AH
AD  - From University of British Columbia and St Paul's Hospital, Vancouver, British
      Columbia, Canada; Palo Alto Veterans Affairs (VA) Health Care System, Palo Alto, 
      and Stanford University School of Medicine, Stanford, California; VA
      Nebraska-Western Iowa Health Care Center and University of Nebraska Medical
      Center, Omaha, Nebraska; Boston University School of Medicine, Boston,
      Massachusetts; and University of Toronto and Mount Sinai Hospital, Toronto,
      Ontario, Canada.
CN  - CSP 551 RACAT Investigators
LA  - eng
PT  - Journal Article
DEP - 20170530
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
RN  - 0 (Antirheumatic Agents)
RN  - 0 (Biological Factors)
RN  - OP401G7OJC (Etanercept)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - AIM
SB  - IM
MH  - Antirheumatic Agents/*economics/*therapeutic use
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Biological Factors/*economics/*therapeutic use
MH  - *Cost-Benefit Analysis
MH  - Drug Therapy, Combination
MH  - Etanercept/therapeutic use
MH  - Female
MH  - Humans
MH  - Life Tables
MH  - Male
MH  - Methotrexate/therapeutic use
MH  - Middle Aged
MH  - Quality-Adjusted Life Years
EDAT- 2017/05/30 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/05/30 06:00
AID - 2629469 [pii]
AID - 10.7326/M16-0713 [doi]
PST - ppublish
SO  - Ann Intern Med. 2017 Jul 4;167(1):8-16. doi: 10.7326/M16-0713. Epub 2017 May 30.