Cost-effectiveness of adalimumab for early-stage Dupuytren's disease : an economic evaluation based on a randomized controlled trial and individual-patient simulation model

Helen Dakin; Ines Rombach; Melina Dritsaki; Alastair Gray; Catherine Ball; Sarah E Lamb; Jagdeep Nanchahal

doi:10.1302/2633-1462.311.BJO-2022-0103.R2

Cost-effectiveness of adalimumab for early-stage Dupuytren's disease : an economic evaluation based on a randomized controlled trial and individual-patient simulation model

Bone Jt Open. 2022 Nov;3(11):898-906. doi: 10.1302/2633-1462.311.BJO-2022-0103.R2.

Authors

Helen Dakin¹, Ines Rombach^{1

2

3}, Melina Dritsaki^{4

5}, Alastair Gray¹, Catherine Ball⁶, Sarah E Lamb^{4

7}, Jagdeep Nanchahal⁶

Affiliations

¹ Health Economics Research Centre, University of Oxford, Oxford, UK.
² Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK.
³ School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.
⁴ Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁵ Department of Economics & Laboratory of Applied Economics, University of Western Macedonia, Kastoria, Greece.
⁶ Kennedy Institute, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁷ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.

PMID: 36378072
PMCID: PMC9709491
DOI: 10.1302/2633-1462.311.BJO-2022-0103.R2

Abstract

Aims: To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren's disease (DD) and the value of further research from an NHS perspective.

Methods: We used data from the Repurposing anti-TNF for Dupuytren's disease (RIDD) randomized controlled trial of intranodular adalimumab injections in patients with early-stage progressive DD. RIDD found that intranodular adalimumab injections reduced nodule hardness and size in patients with early-stage DD, indicating the potential to control disease progression. A within-trial cost-utility analysis compared four adalimumab injections with no further treatment against standard care alone, taking a 12-month time horizon and using prospective data on EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and resource use from the RIDD trial. We also developed a patient-level simulation model similar to a Markov model to extrapolate trial outcomes over a lifetime using data from the RIDD trial and a literature review. This also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded.

Results: The within-trial economic evaluation found that adalimumab plus standard care cost £503,410 per quality-adjusted life year (QALY) gained versus standard care alone over a 12-month time horizon. The model-based extrapolation suggested that, over a lifetime, repeated courses of adalimumab could cost £14,593 (95% confidence interval £7,534 to £42,698) per QALY gained versus standard care alone. If the NHS was willing to pay £20,000/QALY gained, there is a 77% probability that adalimumab with retreatment is the best value for money.

Conclusion: Repeated courses of adalimumab are likely to be a cost-effective treatment for progressive early-stage DD. The value of perfect parameter information that would eliminate all uncertainty around the parameters estimated in RIDD and the duration of quiescence was estimated to be £105 per patient or £272 million for all 2,584,411 prevalent cases in the UK. Cite this article: Bone Jt Open 2022;3(11):898-906.

Keywords: Adalimumab; Anti-tumour necrosis factor; Cost-effectiveness analysis; Dupuytren’s disease; EQ-5D-5L; Economic evaluation; Palmar fibromatosis; Randomized controlled trial; Simulation model; flexion deformities; linear regression models; percutaneous needle fasciotomies; radiotherapy; randomized controlled trials; sensitivity analysis; steroid injections.