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Cost Effectiveness of Therapeutic Interventions in Ankylosing Spondylitis

A Critical and Systematic Review

  • Systematic Review
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Abstract

Objectives

This report reviews the cost effectiveness of different therapeutic interventions used in the treatment of ankylosing spondylitis (AS).

Methods

We performed a systematic search of the databases MEDLINE via PubMed, EMBASE and the Cochrane Library and used hand-searching to identify articles on cost effectiveness of therapies for adult patients with AS published up to November 2010.

Results

Of 135 articles, 13 studies were analysed. Two articles were on physical therapies, one article was on NSAIDs and ten articles were on tumour necrosis factor (TNF) inhibitors (infliximab = 6, etanercept = 2, infliximab and etanercept = 1 and adalimumab = 1). Of the latter, no article directly compared TNF inhibitors. Articles showed substantial heterogeneity in methodological approaches and thus results, which prevented us from any extensive comparison, data pooling or meta-analysis. The incremental cost-effectiveness ratio (ICER) for spa-exercise treatment was €7465 (95% CI 3294, 14 686) per QALY. The ICERs for infliximab, etanercept and adalimumab were €5307–237 010, €29 815–123 761 and €7344-33 303 per QALY, respectively.

Conclusions

Modelling treatment strategies in chronic relapsing diseases such as AS presents specific challenges, as reflected in the variation in the cost-effectiveness results reported. Although quite variable, the cost-effectiveness ratios for AS therapies remain within an acceptable range.

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Acknowledgements

Competing interests: Author disclosures of honoraria for advice or public speaking, grants received and/or advisory board participation are as follows:

CGV: Abbott, BMS, Expansciences, Roche, UCB and Wyeth-Pfizer.

BF: Abbott, BMS, Merck, Mundipharma, Roche, Shering Plough, UCB and Wyeth-Pfizer.

Author contributions: Both authors participated in the conception and design of the study, and contributed to interpretation of the results. CGV and BF drafted the manuscript and are both guarantors of the overall content of this article.

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Authors and Affiliations

  1. Université Pierre et Marie Curie (UPMC) Paris VI, GRC-UMPC 08 (EEMOIS), Paris, France

    Cécile Gaujoux-Viala & Bruno Fautrel MD, PhD

  2. Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France

    Cécile Gaujoux-Viala & Bruno Fautrel MD, PhD

  3. EA 4360 Apemac, Lorraine University, Paris Descartes University, Nancy, France

    Cécile Gaujoux-Viala

  4. service de Rhumatologie, Hôpital Pitié-Salpêtrière, 83 boulevard de l’Hôpital, 75013, Paris, France

    Bruno Fautrel MD, PhD

Authors
  1. Cécile Gaujoux-Viala
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  2. Bruno Fautrel MD, PhD
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Correspondence to Bruno Fautrel MD, PhD.

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Gaujoux-Viala, C., Fautrel, B. Cost Effectiveness of Therapeutic Interventions in Ankylosing Spondylitis. PharmacoEconomics 30, 1145–1156 (2012). https://doi.org/10.2165/11596490-000000000-00000

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