Cost-effectiveness of Biological Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Implications for Clinical Practice
Bibliographic record
Abstract
In this issue of The Journal , Stevenson, et al present an economic model on the cost-effectiveness of biological disease-modifying antirheumatic drugs (bDMARD) for rheumatoid arthritis (RA) in patients who can tolerate methotrexate (MTX)1. Their work formed part of the evidence used by the UK National Institute for Health and Care Excellence (NICE) to update the technology appraisal guidance on the application of bDMARD in RA. In England, because prescription of bDMARD is restricted to patients with RA who have failed at least 2 conventional DMARD and have high disease activity [28-joint Disease Activity Score (DAS28) > 5.1], there was specific interest in the question of whether prescriptions should also be extended to those with moderate disease. The model presented is based on the healthcare setting in England and compares the continuous administration of nonbiological therapy to treatment with sequences of bDMARD in patients with moderate and moderate-to-severe RA. The authors report that the cost per quality-adjusted life-year (QALY) gained by bDMARD strategies over nonbiological DMARD treatment only was £41,600 (US $51,628) for patients with severe RA and £51,100 for patients with moderate to severe RA, a cost well beyond the generally accepted NICE threshold of £20,000–£30,000. In subanalyses, restricting biologicals to patients with the worst prognosis with non-biological therapy only, more favorable cost-effectiveness ratios were found: £25,300 per QALY for severe and £28,500 per QALY for moderate to severe RA. Hence the authors conclude that the cost-effectiveness of the administration of bDMARD in RA in England is questionable and meets currently accepted levels only in subsets of patients with the worst … Address correspondence to Dr. T.M. Kuijper, Maasstad Hospital, Department of Rheumatology, Postbus 9100, 3007 AC Rotterdam, The Netherlands; E-mail: kuijpert{at}maasstadziekenhuis.nl
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.093 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".