Purpose: To investigate the cost-effectiveness of adalimumab in combination with methotrexate, compared with methotrexate alone, for the management of uveitis associated with Juvenile Idiopathic Arthritis (JIA-U).
Design: A cost-utility analysis based on a clinical trial and decision analytic model.
Participants: Children and adolescents aged 2 to 18 years with persistently active JIA-U, despite optimized methotrexate treatment for at least 12 weeks.
Methods: The SYCAMORE trial [ISRCTN10065623] of methotrexate (up to 25mg per week) with or without fortnightly administered adalimumab (20mg or 40mg, according to body weight) provided data on resource use (based on patient self-report and electronic records) and health utilities (from the Health Utilities Index questionnaire). Surgical event rates and long-term outcomes were based on data from a 10-year longitudinal cohort. A Markov model was used to extrapolate the effects of treatment based on visual impairment.
Main outcome measures: Medical costs to the National Health Service in the UK, utility of defined health states, quality-adjusted life years (QALY), and incremental cost per QALY.
Results: Adalimumab in combination with methotrexate resulted in additional costs of £39,316 with a 0.30 QALY gain compared with methotrexate alone, resulting in an incremental cost-effectiveness ratio of £129,025 per QALY gained. The probability of cost-effectiveness at a threshold of £30,000 per QALY was less than 1%. Based on a threshold analysis, a price reduction of 84% would be necessary for adalimumab to be cost-effective.
Conclusions: Adalimumab is clinically effective in JIA-U, however its cost-effectiveness is not demonstrated compared with methotrexate alone in the UK setting.