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Deficiencies in current evaluations of the cost-effectiveness of biologic agents for RA

Nature Clinical Practice Rheumatology volume 5, pages 78–79 (2009)Cite this article

Economic evaluations of health care interventions are intended to inform decision makers, and are becoming more and more common in the medical literature.1 These evaluations bridge the discrepancy between wanting the best possible health care on the one hand, and paying for increased costs on the other. Biologic agents particularly lend themselves to such economic evaluations because their high costs can clearly be a barrier to their supply, either explicitly or implicitly. As discussed in this Viewpoint, however, decision makers seem to be largely uninfluenced by economic evaluations of biologics, which is, at least in part, a result of the quality of the evaluations.

The dominant framework for economic evaluations in health care is the cost per quality-adjusted life-year (QALY) paradigm: new interventions are economically acceptable if increases in costs are compensated by sufficiently large health benefits. Within this framework, health benefits are quantified using QALYs, which contain the patients' disease burden in terms of both survival and quality of life. Because QALYs are a generic measure that can be applied in many different diseases and treatments, they are suitable as a framework to assess whether the costs of interventions, such as biologics, are acceptable. Costs are preferably estimated from a societal perspective,2 including both short-term and long-term health care costs, but also including non-health-care costs, such as informal care, home care and costs to productivity. This broad perspective can have a substantial effect on the determination of which interventions are considered cost-effective for which patients. For example, including costs to productivity favors treatments for young, male patients: their rate of labor participation is high, so treatment costs are more-easily compensated by savings on productivity. Often-quoted acceptability thresholds for cost-effectiveness are $50,000 or $100,000 per QALY.3 These thresholds are not strict, however, because the economic aspect is rarely the only aspect relevant to decision making.

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Author notes

  1. Leiden University Medical Center, Department of Medical Decision Making, J10-S, PO Box 9600, 2300RC Leiden, The Netherlands w.b.van_den_hout@lumc.nl

Authors and Affiliations

  1. WB van den Hout is a Senior Researcher and Health Economist in the Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.,

    Wilbert B van den Hout

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  1. Wilbert B van den Hout
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Competing interests

WB van den Hout performed the economic evaluation of a trial for which his department received a grant from the Dutch Health Care Insurance Board (College voor Zorgverzekeringen). Additional funding for this trial was provided by Centocor and Schering–Plough.

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van den Hout, W. Deficiencies in current evaluations of the cost-effectiveness of biologic agents for RA. Nat Rev Rheumatol 5, 78–79 (2009). https://doi.org/10.1038/ncprheum0985

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