Οικονομική αξιολόγηση ενός βιολογικού ανοσοτροποποιητικού αντιρρευματικού φαρμάκου για την αντιμετώπιση της Νεανικής Ιδιοπαθούς Αρθρίτιδας
Economic evaluation of a biological disease-modifying antirheumatic drug for treating Juvenile Idiopathic Arthritis
SubjectΙατρική περίθαλψη, Κόστος της
Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic disease that occurs in children aged below 16 years and persists for more than 6 weeks and can become a cause of functional impairment. The disease is of unknown etiology, characterized by joint pain, swelling and movement limitation, symptoms caused by inflammation of the synovial membrane of the affected joint. NIA is divided into 7 subtypes based on the clinical features of the disease lasting for more than six months – oligoarthritis, polyarthritis RF+ or RF-, psoriatic arthritis, systemic arthritis, arthritis related to enthesitis and undifferentiated arthritis. The treatment of children with NIA was based on non-steroidal anti-inflammatory drugs, with the addition of corticosteroids. Later, methotrexate, the most common conventional non-biological antirheumatic drug, was used, while the current preferred treatment makes use of the biological drug-modifying drugs. The purpose of this health technology assessment is to evaluate the cost-effectiveness of NIA treated with adalimumab, a biological modifying antirheumatic drug (Humira®, AbbVie) in combination with methotrexate, compared to conventional methotrexate therapy. Patients receiving biologic treatment with adalimumab experienced fewer disease flares as well as fewer adverse events than those treated only with methotrexate. However, there is limited evidence for the clinical effectiveness of the biological treatment in specific subtypes of the disease. Based on the developed independent model for the purposes of the current assessment, the incremental cost-effectiveness ratio (ICERs) for the treatment with adalimumab compared to the conventional treatment with methotrexate is estimated at EUR 25,659 per QALY gained, using the drug price list acquisition costs. Model results are more sensitive to changes in HRQoL utility values. Changes in clinical effectiveness parameters, such as discontinuation of treatment and disease flares, had little effect on the model's results.