Maxime Verhoeven

138 Chapter 7 Table 2 (continued) TCZ+MTX vs. MTX TCZ vs. MTX ICER HC 425,088 539,531 % ( SE , SW, NW, NE) (0,0,7,93) (0,0,26,74) ICER # 458,954 425,144 % ( SE , SW, NW, NE) (0,0,7,93) (0,0,26,74) ICER $ 420,829 533,521 % ( SE , SW, NW, NE) (0,0,7,93) (0,0,26,74) Over 5 years Medication costs 14,600 (9,300 to 19,900) 17,200 (11,700 to 22,500) Direct healthcare costs 19,900 (9,700 to 30,300) -2,700 (-9,700 to 3,800) Indirect non healthcare costs -4,100 (-5,400 to -2,800) -2,800 (-4,300 to -1,400) Productivity loss costs # 5,200 (-8,400 to 18,700) -6,600 (-19,900 to 6,800) Productivity loss costs $ 1,500 (-1,900 to 4,200) 0 (-3,300 to 2,900)   Total cost and effect Healthcare perspective 34,500 (22,200 to 46,600) 14,500 (5,100 to 23,500) Societal perspective # 35,600 (18,700 to 52,200) 5,000 (-10,500 to 20,800) Societal perspective $ 31,600 (19,600 to 43,600) 11,500 (1,700 to 20,900) QALYs 0.06 (-0.10 to 0.22) -0.03 (-0.20 to 0.1) ICER HC 575,982 -426,967 % ( SE , SW, NW, NE) (0,0,23,77) (0,0,65,35) ICER # 594,021 -149,241 % ( SE , SW, NW, NE) (0,0,23,77) (8,18,47,27) ICER $ 526,674 -337,609 % ( SE , SW, NW, NE) (0,0,23,77) (1,0,65,34) Outcomes based on single imputation nested in 10,000 bootstraps, costs expressed in euro’s. TCZ+MTX= initiation of tocilizumab + methotrexate strategy group; TCZ= initiation of tocilizumab + placebo- methotrexate strategy group; MTX= initiation of methotrexate + placebo-tocilizumab strategy group; Medication costs= all RA medication costs; Direct healthcare costs= all costs related to healthcare, also for other diseases (RA medication costs excluded); Indirect non healthcare costs= costs related to patient and family (e.g., travel cost; buying stair lift; etc.); Productivity loss costs= costs related to work loss or being less productive; # = using human capital approach; $ = using friction cost approach, only counting costs for a period of absence up to 85 days; Healthcare perspective= direct healthcare cost + medication cost; Societal perspective= direct healthcare costs + indirect not healthcare costs + productivity loss costs + medication costs; QALY= quality-adjusted life years; ICER= incremental cost effectiveness ratio (using societal perspective according to human capital approach); HC= healthcare perspective; SE = south east: gain in QALY, less expensive (i.e., TCZ dominant); SW= south west: loss in QALY, less expensive; NW= north west: loss in QALY, more expensive (i.e., TCZ inferior); NE= north east: gain in QALY, more expensive.