| Title: |
Cost-effectiveness of risk-stratified blood test monitoring strategies for adults with inflammatory conditions |
| Authors: |
Stevenson, Matt; Nakafero, Georgina; Williams, Hywel C; Card, Tim; Taal, Maarten W; Aithal, Guruprasad P; Fox, Christopher P; Abhishek, Abhishek |
| Publisher Information: |
Oxford University Press |
| Publication Year: |
2025 |
| Collection: |
University of Nottingham: Repository@Nottingham |
| Subject Terms: |
Cost-effectiveness; methotrexate; leflunomide; sulfasalazine; blood monitoring; immune-mediated inflammatory disease |
| Description: |
ObjectivesTo assess the cost-effectiveness of extending the interval between monitoring blood tests beyond 3-monthly intervals during established treatment of adults prescribed low-dose weekly MTX (≤25 mg/week), LEF or SSZ.MethodsPublished prognostic models that estimated the risk of stopping treatment due to abnormal blood test results during 5 years of established treatment were incorporated into a cost-effectiveness model. The consequences of having an extended monitoring period and a delay in stopping treatment was estimated by clinicians as the probability of someone having 1 of the 11 adverse events (AEs) that could be avoided with monitoring. The clinicians erred towards overestimating the risks. The costs and quality-adjusted life year loss of the AEs were sourced from recent National Institute of Health and Care Excellence appraisals or from targeted searches. Incremental net monetary benefit (iNMB) of 6-, 12- and 24-monthly monitoring, compared with three monthly monitoring was calculated for each drug conditional on risk decile.ResultsOur analyses show that extending the duration between monitoring appointments is cost-effective in all scenarios, even in a pessimistic analysis, where the risks of all AEs were tripled, and the costs of some AEs were increased. In the base case, biennial monitoring was often most cost-effective although the iNMB between annual and biennial monitoring was often small.ConclusionExtending the interval between monitoring blood tests appears to be cost-effective with annual monitoring producing consistently good results regardless of assumptions related to risks of AEs, risk decile or treatment. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://nottingham-repository.worktribe.com/output/56419509; Rheumatology; Volume 65; Issue 2 |
| DOI: |
10.1093/rheumatology/keaf623 |
| Availability: |
https://doi.org/10.1093/rheumatology/keaf623; https://nottingham-repository.worktribe.com/file/56419509/1/Cost-effectiveness%20of%20risk-stratified%20blood-test%20monitoring%20strategies%20for%20adults%20with%20inflammatory%20conditions.; https://nottingham-repository.worktribe.com/output/56419509 |
| Rights: |
openAccess ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.881F1774 |
| Database: |
BASE |