Economic evaluation of anti-TNF agents for patients with rheumatoid arthritis in Greece

Figures & data

Table 1 Unit cost per item used in the model

Description	Cost (€)
Etanercept 50 mg/1 mL ×4 prefilled syringe	756.96
Infliximab 100 mg/vial	426.00
Adalimumab 40 mg	381.39
Methotrexate 2.5 mg/tablet, 100 tablet bottle	3.57
Physician office visita	5.00
Day care hospitalizationb	85.00

Notes:

a Ministerial Decision, Y4a/oik105604/27/09/2011

b Government Gazette FEK2080/B2010.

Figure 1 Percent of cases of dose escalation and frequency intensification.

Abbreviation: MTX, methotrexate.

Table 2 The initial dosage scheme of infliximab

Dosage scheme	% of patients
3 mg/kg every 8 weeks (as per label)	70.20%
5 mg/kg every 8 weeks	14.30%
3 mg/kg every 6 weeks	11.90%
5 mg/kg every 6 weeks	3.60%
Total	100.00%

Figure 2 Mean total treatment cost per year for new patient.

Note: Results were based on 10,000 Monte Carlo simulations.
Abbreviation: MTX, methotrexate.

Figure 3 Mean total treatment cost per year for existing patient.

Note: Results were based on 10,000 Monte Carlo simulations.
Abbreviation: MTX, methotrexate.

Table 3 Average cost per patient per year for the base case scenario (in €)

	New patients		Existing patients**
	Nonresponders	Responders*	Responders
Etanercept	2,276 (NA)	9,845 (NA)	9,840 (NA)
Etanercept + MTX	2,278 (NA)	9,857 (NA)	9,852 (NA)
Infliximab + MTX	3,171 (NA)	11,728 (11,642–11,813)	11,342 (10,471–12,211)
Adalimumab	2,293 (NA)	10,389 (10,289–10,485)	11,163 (10,915–11,404)
Adalimumab + MTX	2,296 (NA)	10,400 (10,300–10,497)	11,175 (10,927–11,417)

Notes: Values are expressed as mean (95% UI), where UI was the lower and upper uncertainty interval from 10,000 Monte Carlo simulations.

* Minimum improvement criteria for a responder were the “ACR 20” (the definition requires, among other prerequisites, a 20% improvement in both tender and swollen joint counts);⁵⁸

** previously treated patients who were continuing therapy and who achieved an improvement greater than the minimum criteria of ACR 20.

Abbreviations: ACR, American College of Rheumatologists; MTX, methotrexate; NA, not available; UI, uncertainty interval.

Table 4 Average cost per patient per year for two scenario analysis (in €)

	New patients		Existing patients**
	Nonresponders	Responders*	Responders
Scenario 1 Dose escalation: 2.5% (etanercept), 9.6% (adalimumab), and 35% (infliximab) (DART study^Citation32)
Etanercept	2,276 (NA)	9,938 (9,932–9,944)	10,086 (10,070–10,103)
Etanercept + MTX	2,278 (NA)	9,949 (9,943–9,955)	10,098 (10,082–10,114)
Infliximab + MTX	3,171 (NA)	10,581 (10,496–10,666)	9,133 (8,967 – 9,298)
Adalimumab	2,293 (NA)	10,278 (10,255–10,302)	10,868 (10,807–10,929)
Adalimumab + MTX	2,296 (NA)	10,290 (10,267–10,313)	10,880 (10,819–10,942)
Scenario 2 Dose escalation: 0% (etanercept), 0% (adalimumab), and 55% (infliximab) (Hellenic Registry^Citation46)
Etanercept	2,276 (NA)	9,845 (NA)	9,840 (NA)
Etanercept + MTX	2,278 (NA)	9,857 (NA)	9,852 (NA)
Infliximab + MTX	3,171 (NA)	11,238 (11,124–11,349)	10,397 (10,147–10,645)
Adalimumab	2,293 (NA)	9,921 (NA)	9,916 (NA)
Adalimumab + MTX	2,296 (NA)	9,932 (NA)	9,927 (NA)

Notes: Values are expressed as mean (95% UI), where UI was the lower and upper uncertainty interval from 10,000 Monte Carlo simulations.

* Minimum improvement criteria for a responder were the “ACR 20” (the definition requires, among other prerequisites, a 20% improvement in both tender and swollen joint counts);⁵⁸

** previously treated patients who were continuing therapy and who achieved an improvement greater than the minimum criteria of ACR 20.

Abbreviations: ACR, American College of Rheumatologists; MTX, methotrexate; NA, not available; UI, uncertainty interval.

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