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首页> 外文期刊>Rheumatology >Modelling the cost-effectiveness of biologic treatments for psoriatic arthritis.
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Modelling the cost-effectiveness of biologic treatments for psoriatic arthritis.

机译：模拟银屑病关节炎的生物治疗的成本效益。

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OBJECTIVES: A probabilistic model was developed to determine the cost-effectiveness of three biologics, etanercept, infliximab and adalimumab, compared with palliative care for the treatment of active and progressive PsA in patients who have an inadequate response to standard treatment (including DMARDs). METHODS: A previous model was revised to evaluate the impact of biologics on both skin and joint disease and to include new evidence from the clinical review and evidence synthesis. Initial response to biologics was determined using the PsA response criteria. The impact of biologics on the arthritis component of the disease is then modelled via a change in the HAQ and the impact of the psoriasis component measured using the Psoriasis Area and Severity Index. RESULTS: For PsA patients with mild to moderate skin disease, the incremental cost-effectiveness ratio (ICER) for etanercept vs palliative care is around pound18 000, and the ICER for infliximab vs etanercept is around pound44 000 per quality-adjusted life year (QALY). Adalimumab is extendedly dominated. The probability that etanercept is cost effective is 0.436 at a threshold of pound20 000 per QALY. Etanercept is also likely to be cost effective for patients with moderate to severe psoriasis or negligible skin involvement. CONCLUSIONS: Further investigation is required to reduce uncertainties around a number of model parameters, in particular the length of time over which biologics are assumed to be effective and the progression of HAQ on and off treatment.
机译：目的：开发了一种概率模型，用于确定依那西普，英夫利昔单抗和阿达木单抗这三种生物制剂与对标准疗法（包括DMARDs）反应不足的患者进行主动和进行性PsA姑息治疗相比的成本效益。方法：对先前的模型进行了修订，以评估生物制剂对皮肤和关节疾病的影响，并包括来自临床评价和证据综合的新证据。使用PsA响应标准确定对生物制剂的初始响应。然后，通过HAQ的变化以及使用牛皮癣面积和严重性指数测量的牛皮癣成分的影响，来模拟生物制剂对疾病关节炎成分的影响。结果：对于轻度至中度皮肤疾病的PsA患者，依那西普与姑息治疗的成本效益比（ICER）约为18000英镑，英夫利昔单抗与依那西普的ICER约为4.4万英镑/质量调整生命年（QALY ）。阿达木单抗广泛占据主导地位。依那西普具有成本效益的概率是每QALY 2万英镑的阈值下为0.436。对于中度至重度牛皮癣或皮肤受累可忽略的患者，依那西普也可能具有成本效益。结论：需要进行进一步的研究以减少许多模型参数周围的不确定性，尤其是假设生物制剂有效的时间长度以及HAQ开和关治疗的进展。

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