Drugs 2005; 65 (4): 473-496 REVIEW ARTICLE 0012-6667/05/0004-0473/$39.95/0 © 2005 Adis Data Information BV. All rights reserved. An Overview of Economic Evaluations for Drugs Used in Rheumatoid Arthritis Focus on Tumour Necrosis Factor-α Antagonists Nick J. Bansback, 1,2 Dean A. Regier, 3 Roberta Ara, 1 Alan Brennan, 1 Kamran Shojania, 4 John M. Esdaile, 4 Aslam H. Anis 5 and Carlo A. Marra 3,6 1 Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK 2 Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, British Columbia, Canada 3 Health Economics Program, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada 4 Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada 5 Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada 6 Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada Contents Abstract .................................................................................... 474 1. Methodology ............................................................................ 476 2. Background to Disease ................................................................... 476 2.1 Epidemiology of Rheumatoid Arthritis (RA) .............................................. 476 2.2 Overview of Treatment for RA ......................................................... 476 2.3 Quality of Life in RA .................................................................. 477 2.4 Costs of RA .......................................................................... 477 3. Background to Cost-Effectiveness Models in RA ............................................. 478 4. Critique of Tumour Necrosis Factor-α Cost-Effectiveness Analyses (CEAs), Using the Outcome Measures in Rheumatoid Arthritis Clinical Trials Consensus Statement .......................... 480 4.1 Outcome Measures .................................................................. 480 4.1.1 Clinical Outcome Measures (Element 1) .......................................... 480 4.1.2 Quality-Adjusted Life-Years (Element 2) ........................................... 480 4.2 Quality-of-Life Measurements in RA .................................................... 481 4.3 Obtaining Quality Weightings in RA .................................................... 482 4.4 Applications of Preference-Based Measures in CEAs in RA ............................... 483 4.5 The Health Assessment Questionnaire (HAQ) ............................................ 483 4.6 HAQ Groupings ...................................................................... 484 4.6.1 Adverse Events (Element 3) ..................................................... 485 4.6.2 Mortality (Element 4) ........................................................... 485 4.7 Comparators ........................................................................ 486 4.7.1 Comparing Treatments in the Absence of Head-to-Head Trials (Element 5) .......... 486 4.7.2 Sequences of Treatments (Element 6) ............................................ 486