Etanercept (
Enbrel), which inhibits the activity of tumour
necrosis factor-alpha, is indicated in the treatment of patients with active
rheumatoid arthritis (RA). A lifetime cost-utility analysis in patients with severe
disease-modifying antirheumatic drug (
DMARD)-resistant RA in the UK suggested that
etanercept is associated with acceptable cost-utility ratios relative to traditional nonbiological DMARDs. In a 12-month cost-utility study in Spain,
etanercept was predicted to be dominant over
infliximab plus
methotrexate in patients with active, refractory RA with regards to the cost per QALY gained and cost per American College of Rheumatology (ACR) 20 response achieved. In short-term cost-effectiveness analyses conducted in the US, the cost effectiveness of
etanercept relative to other treatments in patients with
methotrexate-naive or -resistant RA depends on whether predicted incremental cost-effectiveness ratios of at least USD 41,900 per ACR 20 response or USD 34,800 per ACR 70 weighted response over a 6-month period are considered acceptable (1999 values). The relative efficacy and cost effectiveness of
etanercept and other biological DMARDs will be clarified when appropriate data from directly comparative clinical and/or long-term pharmacoeconomic studies become available.
Etanercept may prevent or delay disability, which may produce reductions in nondrug costs that could help offset its acquisition cost.