Cost-utility of COBRA-light versus COBRA therapy in patients with early rheumatoid arthritis: The COBRA-light trial

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective To evaluate if COmbinatie therapie Bij Reumatoïde Artritis (COBRA)-light therapy is cost-effective in treating patients with early rheumatoid arthritis (RA) compared with COBRA therapy. Methods This economic evaluation was performed next to the open-label, randomised non-inferiority COBRA-light trial in 164 patients with early RA. Non-responders to COBRA or COBRA-light received etanercept (50 mg/week) for 3-6 months. The societal perspective analysis took medical direct, non-medical direct and indirect costs into account. Costs were measured with patient cost diaries for the follow-up period of 52 weeks. Bootstrapping techniques estimated uncertainty around the cost-effectiveness ratios, presented in cost-effectiveness planes. Results 164 patients were randomised to either COBRA or COBRA-light strategy. At week 52, COBRA-light proved to be non-inferior to COBRA therapy on all clinical outcome measures. The results of the base-case cost-utility analysis (intention-to-treat analyses) revealed that COBRA-light strategy is more expensive (k9.3 (SD 0.9) compared with COBRA (k7.2 (SD 0.8)), but the difference in costs were not significant (k2.0; 95% CI-0.3 to 4.4). Also, both strategies produced similar quality-adjusted life-years (QALYs). The sensitivity analyses showed robustness of these results. In a per-protocol sensitivity analysis, in which costs of etanercept were assumed to be provided as prescribed according to protocol, both arms had much higher costs: COBRA-light: K11.5 (8.3) compared with k8.5 (6.8) for COBRA, and the difference in costs was significant (k2.9; 0.6 to 5.3). Conclusions In the base-case cost-utility analysis, the two strategies produced similar QALYs for similar costs. But it is anticipated that if protocol had been followed correctly, the COBRA-light strategy would have been more costly due to additional etanercept costs, for a limited health gain. Given the limited added benefit and high costs of starting etanercept in the presence of low disease activity in our trial, such a strategy needs better justification than is available now. Trial registration number 55552928, Results.

Original languageEnglish
Article numbere000502
JournalRMD Open
Volume3
Issue number2
DOIs
Publication statusPublished - 1 Oct 2017

Cite this

@article{afe6d92fce0248b2b3f0fc1bf7eb43f4,
title = "Cost-utility of COBRA-light versus COBRA therapy in patients with early rheumatoid arthritis: The COBRA-light trial",
abstract = "Objective To evaluate if COmbinatie therapie Bij Reumato{\"i}de Artritis (COBRA)-light therapy is cost-effective in treating patients with early rheumatoid arthritis (RA) compared with COBRA therapy. Methods This economic evaluation was performed next to the open-label, randomised non-inferiority COBRA-light trial in 164 patients with early RA. Non-responders to COBRA or COBRA-light received etanercept (50 mg/week) for 3-6 months. The societal perspective analysis took medical direct, non-medical direct and indirect costs into account. Costs were measured with patient cost diaries for the follow-up period of 52 weeks. Bootstrapping techniques estimated uncertainty around the cost-effectiveness ratios, presented in cost-effectiveness planes. Results 164 patients were randomised to either COBRA or COBRA-light strategy. At week 52, COBRA-light proved to be non-inferior to COBRA therapy on all clinical outcome measures. The results of the base-case cost-utility analysis (intention-to-treat analyses) revealed that COBRA-light strategy is more expensive (k9.3 (SD 0.9) compared with COBRA (k7.2 (SD 0.8)), but the difference in costs were not significant (k2.0; 95{\%} CI-0.3 to 4.4). Also, both strategies produced similar quality-adjusted life-years (QALYs). The sensitivity analyses showed robustness of these results. In a per-protocol sensitivity analysis, in which costs of etanercept were assumed to be provided as prescribed according to protocol, both arms had much higher costs: COBRA-light: K11.5 (8.3) compared with k8.5 (6.8) for COBRA, and the difference in costs was significant (k2.9; 0.6 to 5.3). Conclusions In the base-case cost-utility analysis, the two strategies produced similar QALYs for similar costs. But it is anticipated that if protocol had been followed correctly, the COBRA-light strategy would have been more costly due to additional etanercept costs, for a limited health gain. Given the limited added benefit and high costs of starting etanercept in the presence of low disease activity in our trial, such a strategy needs better justification than is available now. Trial registration number 55552928, Results.",
keywords = "cost-utility, Early rheumatoid arthritis, economic evaluation, etanercept, prednisolone",
author = "{Ter Wee}, {Marieke M.} and Coup{\'e}, {Veerle M.H.} and {Den Uyl}, Debby and Blomjous, {Birgit S.} and Esmee Kooijmans and Kerstens, {Pit J.S.M.} and Nurmohamed, {Mike T.} and {Van Schaardenburg}, DIrkjan and Voskuyl, {Alexandre E.} and Maarten Boers and Lems, {Willem F.}",
year = "2017",
month = "10",
day = "1",
doi = "10.1136/rmdopen-2017-000502",
language = "English",
volume = "3",
journal = "RMD Open",
issn = "2056-5933",
publisher = "BMJ Publishing Group",
number = "2",

}

TY - JOUR

T1 - Cost-utility of COBRA-light versus COBRA therapy in patients with early rheumatoid arthritis

T2 - The COBRA-light trial

AU - Ter Wee, Marieke M.

AU - Coupé, Veerle M.H.

AU - Den Uyl, Debby

AU - Blomjous, Birgit S.

AU - Kooijmans, Esmee

AU - Kerstens, Pit J.S.M.

AU - Nurmohamed, Mike T.

AU - Van Schaardenburg, DIrkjan

AU - Voskuyl, Alexandre E.

AU - Boers, Maarten

AU - Lems, Willem F.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objective To evaluate if COmbinatie therapie Bij Reumatoïde Artritis (COBRA)-light therapy is cost-effective in treating patients with early rheumatoid arthritis (RA) compared with COBRA therapy. Methods This economic evaluation was performed next to the open-label, randomised non-inferiority COBRA-light trial in 164 patients with early RA. Non-responders to COBRA or COBRA-light received etanercept (50 mg/week) for 3-6 months. The societal perspective analysis took medical direct, non-medical direct and indirect costs into account. Costs were measured with patient cost diaries for the follow-up period of 52 weeks. Bootstrapping techniques estimated uncertainty around the cost-effectiveness ratios, presented in cost-effectiveness planes. Results 164 patients were randomised to either COBRA or COBRA-light strategy. At week 52, COBRA-light proved to be non-inferior to COBRA therapy on all clinical outcome measures. The results of the base-case cost-utility analysis (intention-to-treat analyses) revealed that COBRA-light strategy is more expensive (k9.3 (SD 0.9) compared with COBRA (k7.2 (SD 0.8)), but the difference in costs were not significant (k2.0; 95% CI-0.3 to 4.4). Also, both strategies produced similar quality-adjusted life-years (QALYs). The sensitivity analyses showed robustness of these results. In a per-protocol sensitivity analysis, in which costs of etanercept were assumed to be provided as prescribed according to protocol, both arms had much higher costs: COBRA-light: K11.5 (8.3) compared with k8.5 (6.8) for COBRA, and the difference in costs was significant (k2.9; 0.6 to 5.3). Conclusions In the base-case cost-utility analysis, the two strategies produced similar QALYs for similar costs. But it is anticipated that if protocol had been followed correctly, the COBRA-light strategy would have been more costly due to additional etanercept costs, for a limited health gain. Given the limited added benefit and high costs of starting etanercept in the presence of low disease activity in our trial, such a strategy needs better justification than is available now. Trial registration number 55552928, Results.

AB - Objective To evaluate if COmbinatie therapie Bij Reumatoïde Artritis (COBRA)-light therapy is cost-effective in treating patients with early rheumatoid arthritis (RA) compared with COBRA therapy. Methods This economic evaluation was performed next to the open-label, randomised non-inferiority COBRA-light trial in 164 patients with early RA. Non-responders to COBRA or COBRA-light received etanercept (50 mg/week) for 3-6 months. The societal perspective analysis took medical direct, non-medical direct and indirect costs into account. Costs were measured with patient cost diaries for the follow-up period of 52 weeks. Bootstrapping techniques estimated uncertainty around the cost-effectiveness ratios, presented in cost-effectiveness planes. Results 164 patients were randomised to either COBRA or COBRA-light strategy. At week 52, COBRA-light proved to be non-inferior to COBRA therapy on all clinical outcome measures. The results of the base-case cost-utility analysis (intention-to-treat analyses) revealed that COBRA-light strategy is more expensive (k9.3 (SD 0.9) compared with COBRA (k7.2 (SD 0.8)), but the difference in costs were not significant (k2.0; 95% CI-0.3 to 4.4). Also, both strategies produced similar quality-adjusted life-years (QALYs). The sensitivity analyses showed robustness of these results. In a per-protocol sensitivity analysis, in which costs of etanercept were assumed to be provided as prescribed according to protocol, both arms had much higher costs: COBRA-light: K11.5 (8.3) compared with k8.5 (6.8) for COBRA, and the difference in costs was significant (k2.9; 0.6 to 5.3). Conclusions In the base-case cost-utility analysis, the two strategies produced similar QALYs for similar costs. But it is anticipated that if protocol had been followed correctly, the COBRA-light strategy would have been more costly due to additional etanercept costs, for a limited health gain. Given the limited added benefit and high costs of starting etanercept in the presence of low disease activity in our trial, such a strategy needs better justification than is available now. Trial registration number 55552928, Results.

KW - cost-utility

KW - Early rheumatoid arthritis

KW - economic evaluation

KW - etanercept

KW - prednisolone

UR - http://www.scopus.com/inward/record.url?scp=85032641681&partnerID=8YFLogxK

U2 - 10.1136/rmdopen-2017-000502

DO - 10.1136/rmdopen-2017-000502

M3 - Article

VL - 3

JO - RMD Open

JF - RMD Open

SN - 2056-5933

IS - 2

M1 - e000502

ER -