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.