Economic consequences of sequencing biologics in rheumatoid arthritis: a systematic review.
Economic consequences of sequencing biologics in rheumatoid arthritis: a systematic review.
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DOI：
10.3111/13696998.2013.763812
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发表时间：
2013-01-01
影响因子：
2.4
通讯作者：
Ringold, Sarah
中科院分区：
文献类型：
--
作者：
Sullivan, Sean D;Alfonso-Cristancho, Rafael;Ringold, Sarah
背景/目的：肿瘤坏死因子- α (anti-TNF)阻滞剂治疗类风湿性关节炎（RA）有效，平均有效率为60-70%。对初始抗肿瘤坏死因子治疗反应不完全的患者通常会转向其他生物治疗，并取得一些成功。然而，对于转向抗tnf或其他非tnf生物治疗是否具有成本效益知之甚少。本研究旨在回顾对RA的各种生物治疗进行测序的经济证据。方法：对已发表和未发表的文献（2000年1月至2012年10月）进行系统综述，研究初始生物治疗失败后测序生物治疗的成本效益。它包括建模和其他经济研究，评估一个或多个生物制剂序列的成本效益。评估非生物测序的研究被排除在外。结果：对现有证据的回顾表明，在抗tnf生物制剂类别中，从一种抗tnf药物转向另一种抗tnf药物的成本效益支持有限。这在很大程度上是由于有限的临床证据支持二线和三线抗肿瘤坏死因子治疗的增量疗效，以及如何和何时评估对一线生物制剂无反应的差异。与抗肿瘤坏死因子药物相比，具有不同作用机制的生物治疗作为二线药物更具成本效益。局限性：并非所有的转换序列和模式，无论是在治疗类别内还是在治疗类别外，都被评估过临床效益和成本效益，限制了对这些发现的解释。结论：在一线治疗失败后，从一种抗tnf药物切换到另一种可能不是一种具有成本效益的治疗策略。然而，当序列中包含非tnf生物制剂时，它们可能比抗tnf特异性循环序列更具成本效益。
BACKGROUND/OBJECTIVE: Tumor necrosis factor-alpha (anti-TNF) blocking agents are effective for the treatment of rheumatoid arthritis (RA), with mean response rates of 60-70%. Patients with incomplete response to initial anti-TNF treatment often are switched to other biologic treatments with some success. However, little is known about whether or not switching to anti-TNF or other non-TNF biologic treatments is cost-effective. This study sought to review the economic evidence of sequencing various biologic treatments in RA.METHODS: A systematic review was conducted of published and unpublished literature (January 2000 to October 2012) on the cost-effectiveness of sequencing biologic treatments in RA after failure of an initial biologic treatment. It included modeling and other economic studies that assessed cost-effectiveness of one or more sequences of biologics. Studies were excluded that evaluated non-biologic sequencing.RESULTS: This review of the available evidence suggests that there is limited evidentiary support favoring the cost-effectiveness of switching from one anti-TNF agent to another within the anti-TNF category of biologics. This is due, in large part, to the limited clinical evidence base supporting the incremental efficacy of second- and third-line anti-TNF treatments and to variation on how and when to assess non-response to the first-line biologic. When compared to anti-TNF agents, biologic treatments with a different mechanism of action are more cost-effective as second-line agents.LIMITATIONS: Not all sequences and patterns of switching, either within or outside of therapeutic class, have been evaluated for clinical benefit and cost-effectiveness, limiting the interpretation of these findings.CONCLUSIONS: Switching from one anti-TNF agent to another after first-line treatment failure may not be a cost-effective treatment strategy. However, when non-TNF biologics are included in the sequence they are likely to be more cost-effective than anti-TNF specific cycling sequences.