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Rodgers M, Epstein D, Bojke L, et al. Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Journals Library; 2011 Feb. (Health Technology Assessment, No. 15.10.)

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Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation.

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Appendix 13Costs used in the York model

Each of the industry models presents different resource use assumptions and unit costs, which are used to cost drug treatment and administration/monitoring of patients. Different assumptions are used regarding the dosing of drugs and resource use for administration and monitoring (see Chapter 4, Comparison of the York Economic Assessment with the manufacturers' models). The current York model sought to generate appropriate costs for each of the treatment options using clinical advice and BSR guidelines to determine the resource use associated with administering drugs and monitoring patients. These items are valued using recently published unit costs and prices. The following sections describe the assumptions made in costing, the associated resource use assumptions, unit costs and cost inputs for the decision model.

Resource use

The current York model assumes that infliximab vials cannot be shared and adopts separate scenarios regarding the use of three or four vials per patient. Infliximab is given at 0, 2 and 6 weeks, followed by every 8 weeks (1.625 every 3 months). Six and a half vials of adalimumab are given in every 3-month cycle. Twenty-six vials of etanercept are given in every 3-month cycle. These assumptions were made in consultation with an expert pharmacist (Carolyn Davies, Central Manchester University Hospitals NHS Foundation Trust, 2009, personal communication).

The York model also assumes a half-day inpatient hospital cost for each infusion of infliximab. A single outpatient visit is assumed for etanercept and adalimumab in the initial 3-month period, followed by a review visit between 3 and 6 months and then every 6 months thereafter.

In the York model it is assumed that, at baseline (in the initial 3-month period), patients will require a FBC, ESR, LFT, U&E, chest radiograph, TB Heaf test, ANA and a dsDNA test. All of these resource use assumptions are taken from the previous York model following the BSR guidelines for the use of biologics.

The resource use assumed as part of drug use, administration and monitoring for the various treatment options are shown in Table 64. All resource use was validated by clinical input.

TABLE 64. Resource use associated with drug administration and monitoring.

TABLE 64

Resource use associated with drug administration and monitoring.

Unit costs

All drug costs were taken from the recent version of the BNF.65 The costs of inpatient hospital visits were taken from NHS Reference Costs 2008–09230 and is for an elective excess bed-day for inflammatory spine, joint or connective tissue disorders without complications. An inpatient day is assigned a cost of £144 per half day. The cost of an outpatient visit is also taken from NHS Reference Costs 2008–09 and is for a follow-up visit in rheumatology. Each outpatient visit costs £116. Costs associated with laboratory tests relating to the monitoring of patents, were taken from the previous York model,177 updated to reflect 2009 prices. All unit costs used in the current York model are shown below in Table 65.

TABLE 65. Unit costs used in the York model.

TABLE 65

Unit costs used in the York model.

Costs used in the current York model

The resource use items presented in Table 64 were multiplied by the unit costs in Table 65 to generate cost inputs for the decision model. Costs were calculated for the initial 3-month period, 3- to 6-month period, and all subsequent 3-month periods. These costs are presented in Table 66.

TABLE 66. Costs used in the York model.

TABLE 66

Costs used in the York model.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

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