Article Figures & Data
Figures
- Figure 1.
Cost (€ × 1000) over time per initial treatment strategy in means. Outcomes based on single imputation nested in 10,000 bootstraps; costs expressed in euros. TCZ + MTX: initiation of TCZ + MTX; TCZ: initiation of TCZ + placebo-MTX; MTX: initiation of MTX + placebo-TCZ. Indirect nonhealthcare costs: costs related to patient and family (e.g., travel costs, buying stair lift); direct healthcare costs: all costs related to healthcare, also for other diseases (RA medication costs excluded); productivity loss costs: costs related to work loss or being less productive; other medication costs: all RA medication costs, including NSAID and csDMARD (excluding bDMARD). bDMARD: biologic disease-modifying antirheumatic drug; csDMARD: conventional synthetic disease-modifying antirheumatic drug; MTX: methotrexate; NSAID: nonsteroidal antiinflammatory drug; RA: rheumatoid arthritis; TCZ: tocilizumab.
- Figure 2.
Cost-effectiveness planes for the TCZ-based initiation treatment strategy groups versus the MTX initiation strategy group over 5 years, using the societal perspective (human capital approach). TCZ + MTX: initiation of TCZ + MTX strategy group; TCZ: initiation of TCZ + placebo-MTX strategy group; MTX: initiation of MTX + placebo-TCZ strategy group. TCZ dominated (i.e., more QALY and lower costs) in 8% of all bootstrap samples (8% chance that the intervention is cost effective) compared to MTX. MTX: methotrexate; QALY: quality-adjusted life-years; TCZ: tocilizumab.
- Figure 3.
Cost-effectiveness acceptability curve for the TCZ-based initiation treatment strategy groups versus the MTX initiation strategy group over 5 years, using the societal perspective (human capital approach). TCZ + MTX: initiation of TCZ + MTX strategy group; TCZ: initiation of TCZ + placebo-MTX strategy group; MTX: initiation of MTX + placebo-TCZ strategy group. Using a willingness to pay of €50,000, the probability that TCZ + MTX or TCZ is more cost effective compared to MTX is 0% or 20%, respectively. MTX: methotrexate; TCZ: tocilizumab.
Tables
TCZ + MTX, n = 106 TCZ, n = 103 MTX, n = 108 Employed, n (%) 85 (80) 79 (77) 87 (81) Working hours per week, mean (SD) 24.0 (15.3) 22.1 (15.5) 24.6 (15.8) Female, n (%) 65 (61) 78 (76) 69 (64) RF+, n (%) 75 (71) 68 (66) 86 (80) Anti-CCP +, n (%) 72 (68) 67 (65) 84 (78) RF-and/or anti-CCP+, n (%) 79 (75) 77 (75) 93 (86) Age, yrs, median (IQR) 53.0 (46.0–60.0) 55.0 (47.0–63.0) 53.0 (44.5–62.0) Symptom duration, days, median (IQR) 24.5 (16.0–41.5) 25.5 (18.0–45.0) 27.0 (15.0–46.0) DAS28, mean (SD) 5.2 (1.1) 5.3 (1.1) 5.1 (1.2) HAQ, mean (SD) 1.1 (0.67) 1.3 (0.66) 1.1 (0.59) Included in posttrial follow-up, n (%) 75 (71) 79 (77) 72 (67) TCZ + MTX: initial TCZ + MTX strategy group; TCZ: initial TCZ + placebo-MTX strategy group; MTX: initial MTX + placebo-TCZ strategy group. Anti-CCP: anticyclic citrullinated peptide antibodies; DAS28: disease activity score in 28 joints (range 0–9.4; higher is more activity); HAQ: Health Assessment Questionnaire (range 0–3; 3 = worst function); MTX: methotrexate; RF: rheumatoid factor; TCZ: tocilizumab.
- Table 2
Mean (2.5–97.5 percentile) difference in costs (€, rounded to the nearest hundreds) and QALY, and ICER with distribution in cost-effectiveness plane (%).
TCZ + MTX vs MTX TCZ vs MTX Over 2 years Medication costs 14,800 (12,000 to 17,600) 15,900 (13,100 to 18,600) Direct healthcare costs 8700 (4100 to 13,400) –1400 (–4700 to 1800) Indirect nonhealthcare costs –600 (–1200 to 0) 200 (–700 to 1100) Productivity loss costs# 2500 (–4200 to 9300) –3200 (–9900 to 3400) Productivity loss costs$ 400 (–1100 to 1900) –300 (–1900 to 1200) Total cost and effect Healthcare perspective† 23,500 (18,000 to 29,000) 14,500 (10,000–18,900) Societal perspective# 25,300 (17,200 to 33,300) 11,400 (3600–19,300) Societal perspective$ 23,200 (17,800 to 28,600) 14,400 (9600–19,000) QALY 0.06 (–0.02 to 0.13) 0.03 (–0.05 to 0.11) ICERHC 425,088 539,531 % (SE, SW, NW NE) 0, 0, 7, 93 (0, 0, 26, 74) ICER# 458,954 425,144 % (SE, SW, NW NE) 0, 0, 7, 93 (0, 0, 26, 74) ICER$ 420,829 533,521 % (SE, SW, NW NE) 0, 0, 7, 93 (0, 0, 26, 74) Over 5 years Medication costs 14,600 (9300 to 19,900) 17,200 (11,700–22,500) Direct healthcare costs 19,900 (9700 to 30,300) –2,700 (–9700 to 3800) Indirect nonhealthcare costs –4,100 (–5400 to –2800) –2,800 (–4300 to –1400) Productivity loss costs# 5200 (–8400 to 18,700) –6,600 (–19,900 to 6800) Productivity loss costs$ 1500 (–1900 to 4200) 0 (–3300 to 2900) Total cost and effect Healthcare perspective 34,500 (22,200 to 46,600) 14,500 (5100 to 23,500) Societal perspective# 35,600 (18,700 to 52,200) 5,000 (–10,500 to 20,800) Societal perspective$ 31,600 (19,600 to 43,600) 11,500 (1700–20,900) QALYs 0.06 (–0.10 to 0.22) –0.03 (–0.20 to 0.1) ICERHC 575,982 –426,967 % (SE, SW, NW NE) (0, 0, 23, 77) (0, 0, 65, 35) ICER# 594,021 –149,241 % (SE, SW, NW NE) (0, 0, 23, 77) (8, 18, 47, 27) ICER$ 526,674 –337,609 % (SE, SW, NW NE) (0, 0, 23, 77) (1, 0, 65, 34) Outcomes based on single imputation nested in 10,000 bootstraps; costs expressed in euros. TCZ + MTX: initiation of TCZ + MTX strategy group; TCZ: initiation of TCZ + placebo-MTX strategy group; MTX: initiation of MTX + placebo-TCZ strategy group. Medication costs: all RA medication costs; direct healthcare costs: all costs related to healthcare (also for other diseases; RA medication costs excluded); indirect nonhealthcare costs: costs related to patient and family (e.g., travel costs, buying stair lift); productivity loss costs: costs related to work loss or being less productive.
↵†Healthcare perspective: direct healthcare cost + medication cost; societal perspective: direct healthcare costs + indirect nonhealthcare costs + productivity loss costs + medication costs.
↵#Using human capital approach.
↵$Using friction cost approach, only counting costs for a period of absence up to 85 days. HC: healthcare perspective; ICER: incremental cost-effectiveness ratio (using societal perspective according to human capital approach); MTX: methotrexate; QALY: quality-adjusted life-years; TCZ: tocilizumab; SE: south-east (gain in QALY, less expensive; i.e., TCZ dominant); SW: southwest (loss in QALY, less expensive); NW: northwest (loss in QALY, more expensive; i.e., TCZ inferior); NE: northeast (gain in QALY, more expensive).
- Table 3
Mean (2.5–97.5 percentile) difference in costs (€, rounded to the nearest hundred) and QALY, and ICER with distribution in cost-effectiveness plane (%)
Analysis Over 5 Years TCZ + MTX vs MTX TCZ vs MTX Base case Societal perspective# 35,600 (18,700–52,200) 5000 (–10,500 to 20,800) QALY 0.06 (–0.10 to 0.22) –0.03 (–0.20 to 0.13) ICER# 594,021 –149,241 % (SE, SW, NW, NE) (0, 0, 23, 77) (8, 18, 47, 27) Sensitivity analyses Complete case Societal perspective# 30,400 (9100–51,200) 10,100 (–9900 to 29,700) QALY 0.01 (–0.14 to 0.16) –0.16 (–0.32 to 0.00) ICER# 3,586,015 –64,263 % (SE, SW, NW, NE) (0, 0, 46, 54) (0, 16, 81, 3) QALY +0.05 intervention Societal perspective# 35,600 (18,700 to 52,200) 5000 (–10,500 to 20,800) QALY 0.12 (–0.04 to 0.28) 0.02 (–0.14 to 0.19) ICER# 296,907 194,208 % (SE, SW, NW, NE) (0, 0, 7, 93) (15, 11, 27, 47) QALY –0.05 intervention Societal perspective# 35,600 (18,700 to 52,200) 5000 (–10,500 to 20,800) QALY 0.00 (–0.16 to 0.16) –0.09 (–0.25 to 0.07) ICER# –849,242,215 –53,908 % (SE, SW, NW, NE) (0, 0, 50, 50) (3, 24, 63, 10) Discounting 4% for costs and QALY Societal perspective# 35,600 (18,700 to 52,200) 5000 (–10,500 to 20,800) QALY 0.06 (–0.09 to 0.22) –0.03 (–0.18 to 0.13) ICER# 595,474 –186,561 % (SE, SW, NW, NE) (0, 0, 22, 78) (9, 18, 45, 28) Scenario analyses TCZ-SC Societal perspective# 31,700 (14,900 to 48,000) –200 (–15,400 to 15,100) QALY 0.06 (–0.10 to 0.22) –0.03 (–0.20 to 0.13) ICER# 528,655 4539 % (SE, SW, NW, NE) (0, 0, 23, 77) (16, 35, 30, 19) TCZ-SC –10% Societal perspective# 30,500 (13,700 to 46,800) –1700 (–16,700 to 13,400) QALY 0.06 (–0.10 to 0.22) –0.03 (–0.20 to 0.13) ICER# 508,807 51,233 % (SE, SW, NW, NE) (0, 0, 23, 77) (19, 40, 26, 15) TCZ-SC –30% Societal perspective# 28,100 (11,400 to 44,500) –4,900 (–2000 to 9900) QALY 0.06 (–0.10 to 0.22) –0.03 (–0.20 to 0.13) ICER# 468,847 145,244 % (SE, SW, NW, NE) (0, 0, 23, 77) (25, 49, 16, 10) Subgroup DAS 28 > 5.1 Societal perspective# 34,400 (11,100 to 57,400) 1,400 (–21,100 to 23,600) QALY 0.07 (–0.17 to 0.30) –0.01 (–0.25 to 0.24) ICER# 509,695 –257,000 % (SE, SW, NW, NE) (0, 0, 29, 71) (21, 24, 28, 27) Outcomes based on single imputation nested in 10,000 bootstraps; costs expressed in euros. TCZ + MTX: initiation of TCZ + MTX strategy group; TCZ: initiation of TCZ + placebo-MTX strategy group; MTX: initiation of MTX + placebo-TCZ strategy group. Societal perspective: direct healthcare costs + indirect nonhealthcare costs + productivity loss costs + medication costs.
↵#Using human capital approach. DAS28: Disease Activity Score in 28 joints; ICER: incremental cost-effectiveness ratio (using societal perspective according to human capital approach); QALY: quality-adjusted life-years; SE: southeast (gain in QALY, less expensive; i.e., TCZ dominant); SW: southwest (loss in QALY, less expensive); NW: northwest (loss in QALY, more expensive; i.e., TCZ inferior); NE: northeast (gain in QALY, more expensive); MTX: methotrexate; SC: subcutaneous; TCZ: tocilizumab.
200067 Video Abstract
Files in this Data Supplement:
