-
Views
-
Cite
Cite
B. M. Rothschild, Infliximab cost-effectiveness/safety?, Rheumatology, Volume 42, Issue 12, December 2003, Pages 1572–1573, https://doi.org/10.1093/rheumatology/keg409
Close - Share Icon Share
Extract
Sir, There is no question that tumour necrosis factor inhibitors have made a major difference in our ability to control rheumatoid arthritis. Claims [1–4] related to cost-effectiveness of one such inhibitor, infliximab (Remicade), must be more closely examined.
It is ‘bothersome’ to find allegations that one can demonstrate lifetime cost-effectiveness based on limitation of use to only 1 or 2 yr of therapy [1–4] with a medication whose benefits disappear to baseline with its cessation [5, 6]. Kobelt et al.'s [1] recent article must be reconciled with their 2001 American College of Rheumatology meeting presentation [2]. They reported US$6600 extra cost offset the direct costs of methotrexate therapy by $1190, suggesting a cost per ‘quality of life’ gain of $29 900. This study was very difficult to assess, as multiple clinical trials were combined and their listed direct product cost was less than half that in clinical practice in both the UK and the USA. They reported a cost-effectiveness ratio of $38 200 per discounted quality-adjusted life year (QALY). However, this (similar to the present study) was predicated on the use of infliximab for no more than 2 yr! Their more recent study is similarly difficult to interpret, as it uses historical controls of individuals with early rheumatoid arthritis (different catchment group from infliximab group) from a disparate time period (5–15 yr prior). The assumption that treatment approaches were the same for the historical and infliximab groups makes the unwarranted assumption of absence of progress in rheumatological care approaches over that time period.
Comments