The Sheffield RA Models
Jon Tosh
School of Health and Related Research (ScHARR)
University of Sheffield
PLEASE DO NOT REPRODUCE
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The Sheffield RA Models: Etanercept, BSRBR, AHRQ, and DMARDs, Schemes and Mind Maps of Swedish
An overview of the Sheffield RA Models developed by the School of Health and Related Research (ScHARR) at the University of Sheffield. The models evaluate the cost-effectiveness of various treatments for rheumatoid arthritis (RA), including Etanercept, TNF-α inhibitors, and DMARDs. The models use individual patient sampling, generate simulated patients, and estimate total costs and quality-adjusted life years (QALYs). The document also discusses key assumptions and conclusions of the models.
Typology: Schemes and Mind Maps
2021/2022
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The Sheffield RA Models
Jon Tosh
School of Health and Related Research (ScHARR)
University of Sheffield
PLEASE DO NOT REPRODUCE
Presentation
Introduction
The ScHARR Model(s)
Etanacept Model
BSRBR Model
AHRQ Model
DMARDs Model
Key Assumptions
Conclusions
The ScHARR Model(s)
Individual Patient Sampling (IPS) model
Generates a simulated patient with a set ofcharacteristics
Patient{age,gender,HAQ,disease duration,DMARDs,TNFs}
Evaluates patient’s HAQ score over their lifetime
Estimates total cost and total QALYs
Model runs 000’s patients to estimate mean totalcost and total QALYs
Allows the comparison of alternative treatments
Incorporates uncertainty
HAQ
Time
HAQ
1. Baseline HAQ 2. Receive Tx1 3. Initialresponse to Tx
4. HAQ progression on treatment
6. HAQ‘rebounds’
7. Receive Tx
5. Stop Tx
Etanercept Model
Parameter Etanercept DMARDs ACR20 response (%) Patient level trial data RCT DMARD arms Treatment withdrawal Observational data Observational data ACR20 HAQ improvement Patient level trial data Trial data mean HAQ improvement • Adjusted for disease duration • Adjusted for ACR20 responders only HAQ progression -responders Trial evidence applied to DMARDbase rate Pooled analysis from systematic review HAQ progression –non-responders ERAS observational data ERAS observational data HAQ ‘rebound’ afterwithdrawal Rebound equal to initial gain Rebound equal to initial gain Healthcare costs Applied linear function between HAQ and costs • Evidence taken from Swedish and US studies Utility Pooled relationship of HAQ to utility taken from four published studies
BSRBR Model
Was a research project using the British Societyfor Rheumatology Biologics Registry (BSRBR)dataset
Evaluates TNF-α inhibitors as third line therapy vssequential DMARD therapy
BSRBR provided patient level data
DAS28, HAQ and SF-36 outcomes
Patient level data allowed multivariate analysisfor parameters
TNF-α inhibitors £24k per QALY vs DMARDmonotherapy
AHRQ Model
Was a research project for the MedicarePrescription Drug Improvement andModernization Act (MMA)
Supported by the US Agency for Healthcare Researchand Quality (AHRQ)
Evaluates infliximab, etanercept, adalimumaband anakinra in patients who had not failed abiologic
Incorporates data from the National Databank forRheumatic Diseases (NDB)
Recommends the use of etanercept oradalimumab, and not infliximab or anakinra
AHRQ Model
Parameter TNF-α inhibitors Sub ACR20, ACR20 and ACR Published Mixed Treatment Comparison Treatment withdrawal BSRBR data – multivariate Weibull ACR HAQ improvement Multivariate analysis from the NDB HAQ progression Multivariate analysis from the NDB HAQ ‘rebound’ after withdrawal Rebound equal to initial gain Healthcare costs NDB HAQ to Medicare cost relationship derived Utility Multivariate analysis from the NDB – US EQ-5D
DMARDs Model
Parameter Combination DMARDs Monotherapy DMARD Sub ACR20, ACR20 and ACR50 response Mixed treatment comparison Meta-analysis Treatment withdrawal Trial withdrawal rate with constant risk ACR HAQ improvement AHRQ model analysis HAQ progression Published observational analysis HAQ ‘rebound’ after withdrawal Rebound equal to initial gain Healthcare costs Resource Utilisation Norfolk Arthritis Register (NOAR) HAQ toCost function Utility Published HAQ to EQ-5D function
Key Assumptions (1)
Rebound
Time
HAQ
Equal to gainRebound to baseline
Rebound to Natural History point
The natural history progression rate isfaster/steeper than the progression ratewhile on treatment