Infliximab: a pharmacoeconomic review of its use in XXXX .

@entity1 @entity39 @entity5 @entity1499 @entity309
Infliximab (Remicade), a biological disease-modifying antirheumatic drug (DMARD), binds to and inhibits the activity of @entity5 @entity39 factor-alpha, which is thought to play an important role in the pathophysiology of @entity309 . Intravenous infliximab plus @entity1499 is recommended in @entity1 with @entity309 who have not achieved satisfactory disease control with adequate courses of other DMARDs. Pharmacoeconomic analyses have been based on efficacy data from the pivotal placebo-controlled Anti- @entity5 Necrosis Factor Trial in @entity309 with Concomitant Therapy (ATTRACT) trial in @entity1 with active, refractory @entity309 . Infliximab every 8 weeks plus @entity1499 demonstrated rapid and sustainable improvements in clinical response, delayed radiographic progression, and/or improved functional status and health-related QOL compared with placebo plus @entity1499 at weeks 30, 54 and 102. In cost-utility analyses of infliximab plus @entity1499 conducted from a healthcare payer and/or societal perspective in the US, Europe, Portugal, Sweden and the UK, infliximab 3 mg/kg every 8 weeks plus @entity1499 was associated with acceptable (< US50,000 per discounted QALY gained) cost-utility ratios relative to @entity1499 alone in @entity1 with active, refractory @entity309 . When only direct costs were considered, the lifetime incremental cost per discounted QALY gained with infliximab plus @entity1499 relative to @entity1499 alone was  US30,500-38,700 (year of costing 1998 or not reported; treatment duration 54 or 102 weeks or lifelong) in the US and Europe analyses, and euro39 500 (year of costing not reported; lifelong treatment) in the Portuguese analysis. The cost-utility ratios were more favourable when lost productivity costs or the additional benefit of infliximab on radiographic stabilisation were considered. In the Swedish and UK analyses with a 10-year time horizon, infliximab plus @entity1499 for 1 or 2 years was associated with cost-utility ratios of euro28 600-56 100 (year of costing not reported) when direct costs were considered, and euro3440-48 200 when direct costs plus loss-of-productivity costs were considered. In conclusion, cost-utility analyses, which were based on modelling of data from the pivotal clinical trial of infliximab plus @entity1499 , indicate that infliximab plus @entity1499 is associated with acceptable cost-effectiveness ratios (< US50,000 per discounted QALY gained) relative to @entity1499 monotherapy in @entity1 with active @entity309 who have not responded to previous @entity1499 or other DMARD therapy. The cost effectiveness of infliximab versus other DMARDs is at present unclear, but will be clarified when appropriate data from directly comparative clinical and/or pharmacoeconomic studies become available. In @entity1 in whom adequate courses of other DMARDs have failed to achieve satisfactory disease control, infliximab plus @entity1499 may prevent or delay disability, which may produce reductions in nondrug costs that can help offset its acquisition cost.
