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Introduction to economic modeling for clinical rheumatologists: application to biologic agents in rheumatoid arthritis

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Abstract

Rheumatoid arthritis (RA) is a chronic, debilitating inflammatory, progressive musculoskeletal disease that affects 0.5–1.0% of the adult population in Western countries. The joint destruction and progressive functional disability associated with uncontrolled RA result in tremendous impacts on health-related quality of life, ability to work, and mortality. In addition, the treatment of the disease and associated complications exact a substantial economic burden to the patients, their families, and society. In the last decade, several biological agents (biologics) have been approved for use in RA, revolutionizing treatment. These biologics, which target cytokines such as tumor necrosis factor or lymphocytes such as B or T cells, reduce functional disability and substantially slow the progression of joint damage. However, because these agents typically cost ten to 100 times more than existing available older drug therapies, there has been worldwide concern regarding their impact on healthcare budgets. As such, there has been increased attention towards economic evaluation as a means to determine whether, and in which subgroup of patients, these newer, more expensive agents confer appropriate value for their additional cost. Indeed, evaluations have guided coverage decisions for both private and public health insurance agencies such as the National Institute for Health and Clinical Excellence in the UK. The use of economic evaluations to determine value for money for these agents has attracted both debate and controversy. Some of the controversy is related to the appropriateness of the structure of, and assumptions underlying, the decision models employed to estimate the long-term costs and benefits of these agents over existing therapies. To fully appreciate the debate, one must first understand the basic principles of economic evaluation and the necessity for using decision models to evaluate cost effectiveness. To understand the basic principles of economic evaluation, we refer the reader to an introductory article aimed at clinical rheumatologists. This paper attempts to explain the rationale for the use of economic modeling approaches to assess the value of biologics for RA using specific examples from the literature.

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Acknowledgements

Carlo Marra is a Government of Canada Research Chair in Pharmaceutical Outcomes and a Michael Smith Foundation for Health Research Scholar.

Conflict of interests

The content of this article is the sole responsibility of the authors. Medical writing assistance for the preparation of this article was provided by Synergy who received financial support from Pfizer. C. Marra has received honoraria from Pfizer for consulting. N. Bansback has no financial relationship with Pfizer or any other pharmaceutical company. A. Anis has received honoraria from Abbott, Eli Lilly, Pfizer and Schering for consulting, and has received research support from Abbott and Pfizer. K. Shojania has received honoraria from Abbott, Amgen, Bristol-Myers Squibb, Merck and Roche for speaking and consulting, and has received research grants from Abbott, Bristol-Myers Squibb, Merck and Roche. K. Shojania has no financial relationship with Pfizer.

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Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, BC, V6T 1Z3, Canada

    Carlo A. Marra

  2. Arthritis Research Centre, Vancouver, BC, Canada

    Carlo A. Marra

  3. Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada

    Carlo A. Marra, Nick Bansback & Aslam H. Anis

  4. School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Aslam H. Anis

  5. Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Kamran Shojania

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  1. Carlo A. Marra
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Correspondence to Carlo A. Marra.

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Marra, C.A., Bansback, N., Anis, A.H. et al. Introduction to economic modeling for clinical rheumatologists: application to biologic agents in rheumatoid arthritis. Clin Rheumatol 30 (Suppl 1), 9–18 (2011). https://doi.org/10.1007/s10067-010-1635-8

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