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methods to analyse the economic benefits of a pharmacogenetic pgt test to predict response to biologic therapy in rheu

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methods to analyse the economic benefits of a pharmacogenetic pgt test to predict response to biologic therapy in rheu

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    1. Methods to Analyse The Economic Benefits of a Pharmacogenetic (PGt) Test to Predict Response to Biologic Therapy in Rheumatoid Arthritis, and to Prioritise Further Research

    2. “Biologics”

    3. “Biologics”

    4. “Biologics”

    5. “Biologics”

    6. “Biologics”

    7. Health Outcomes ACR20 response -20% in swollen, and tender joints, and in 3 other measures

    8. Health Outcomes ACR20 response -20% in swollen, and tender joints, and in 3 other measures ACR20 = 0.88 * Swollen50 score (trial data)

    9. Health Outcomes ACR20 response -20% in swollen, and tender joints, and in 3 other measures ACR20 = 0.88 * Swollen50 score (trial data) Response ==> symptom relief and delayed progression long term

    10. Health Outcomes ACR20 response -20% in swollen, and tender joints, and in 3 other measures ACR20 = 0.88 * Swollen50 score (trial data) Response ==> symptom relief and delayed progression long term “Years in ACR20 Response” = primary outcome 3 Kobelt et al. Economic Conseque of Progression of RA in Swe. A&R 1999

    11. Health Outcomes ACR20 response -20% in swollen, and tender joints, and in 3 other measures ACR20 = 0.88 * Swollen50 score (trial data) Response ==> symptom relief and delayed progression long term “Years in ACR20 Response” = primary outcome ACR 20 Response ? 0.8 reduction in HAQ (0 to 3 scale) Utility ? 0.86 - 0.2 * HAQ 3 3 Kobelt et al. Economic Conseque of Progression of RA in Swe. A&R 1999

    12. Existing Uncertainty

    13. 2 Year Treatment Sequence Pathway Initial Response Longer term discontinuation

    14. A Pharmaco-Genetic Strategy

    15. Strategy Sequences to Compare A Anakinra PGt Genetic E Etanercept I Infliximab - Maintenance

    16. Existing Uncertainty (2)

    17. Cost Assumptions Drugs and Monitoring Other Healthcare ? HAQ $Cost pa = $1,084 + $1,636 * HAQ 4 ==> Responder = $ 2,400 pa Non Responder = $ 3,700 pa PGt = $200 Excluding :Nursing Home Care, Employer Costs No uncertainty analysis 4 Yelin and Wanke . A&R 1999………...

    18. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    19. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    20. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    21. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    22. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    23. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    24. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    25. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    26. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    27. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    28. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    29. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    30. 2 Level EVSI - Research Design4, 5 4 Brennan et al Poster SMDM 2002 5 Brennan et al Poster SMDM 2002

    31. 4 strategies: A, E, I and PGt Results - 6 months

    32. 4 strategies: A, E, I and PGt Results - 6 months

    33. 4 strategies: A, E, I and PGt Results - 6 months

    34. 20 strategies: A, E, I and PGt sequences Base-case Results - 2 years

    35. 20 strategies: A, E, I and PGt sequences Optimal Strategy Depends on Threshold: $10k ==> maintenance therapy (20) $20k ==> sequence of 2 biologics (11) $25k ==> PGt + 2 biologics (9) $30k ==> PGt + 3 biologics (19) Base-case Results - 2 years

    36. 20 strategies: A, E, I and PGt sequences Optimal Strategy Prob Depends on Threshold: Optimal $10k ==> maintenance therapy (20) 100% $20k ==> sequence of 2 biologics (11) 42% $25k ==> PGt + 2 biologics (9) 18% $30k ==> PGt + 3 biologics (19) 43% Base-case Results - 2 years

    37. Incorporating Uncertainty Assuming 25,000 per annum new patients starting biologics over next 5 years

    38. Partial EVPI: Key Uncertainties

    39. Partial EVPI: Key Uncertainties

    40. Partial EVSI: PGt Research only

    41. Interleukin Genetics Inc. TARGET RA program Conceptual modelling identified key missing data and helped prioritise further primary data collection 1. PGt test performance (increased sample size). 2. Etanercept / Infliximab performance in gene subgroups 3. Anakinra response rate in anti-TNFa failures

    42. Partial EVPI: TARGET RA Program

    43. Conclusions Early economic evaluation suggests potential for a cost-effective pharmacogenetic test.

    44. Conclusions Early economic evaluation suggests potential for a cost-effective pharmacogenetic test. Expected value of information analysis has quantified the key research priorities.

    45. Conclusions Early economic evaluation suggests potential for a cost-effective pharmacogenetic test. Expected value of information analysis has quantified the key research priorities. EVSI can quantify the value of the specific research design

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