TY - JOUR

T1 - Cost-effectiveness analysis of adalimumab for the treatment of uveitis associated with Juvenile Idiopathic Arthritis

AU - Hughes, Dyfrig A.

AU - Culeddu, Giovanna

AU - Plumpton, Catrin O.

AU - Wood, Eifiona

AU - Dick, Andrew D.

AU - Jones, Ashley P.

AU - McKay, Andrew

AU - Williamson, Paula R.

AU - Compeyrot Lacassagne, Sandrine

AU - Hardwick, Ben

AU - Hickey, Helen

AU - Woo, Patricia

AU - Beresford, Michael W.

AU - Ramanan, Athimalaipet V.

N1 - This project was funded by the National Institute for Health Research Health Technology Assessment Programme (project 09/51/01) and Arthritis Research UK (grant reference 19612).

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - Anti-TNF

KW - Juvenile Idiopathic Arthritis

KW - uveitis

KW - Cost-effectiveness

KW - Economic Evaluation

U2 - 10.1016/j.ophtha.2018.09.043

DO - 10.1016/j.ophtha.2018.09.043

M3 - Article

VL - 126

SP - 415

EP - 424

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 3

ER -