Pharmacoéconomie : accès libre

A Systematic Literature Review and Critical Appraisal of Economic Modelling Approaches of Pharmacologic Interventions for Systemic Lupus Erythematosus (SLE)

Abstract

Tolley K, Cranmer H, Desta B, Tummala R and Tafesse E

Background: Systemic lupus erythematosus (SLE) is a complex, autoimmune disorder with long-term health consequences. Economic evaluation is used by health technology assessment (HTA) bodies to guide drug pricing and reimbursement decisions.
Objective: To conduct a systematic review to identify published economic analyses of pharmacologic treatments for SLE and summaries and critically appraise the modelling techniques used.
Methods: Electronic database searches were performed from January–February 2017. Supplementary searches of conference proceedings and HTA websites were conducted. Reference lists of included papers were examined for relevant studies.
Result: Fifteen relevant economic analyses were identified; all compared belimumab plus standard of care (SOC) with SOC. Most were full economic evaluations (n=13), with two considering a budget impact analysis alone. Eleven used a simulation structure to model interdependencies between multiple dimensions of SLE; one original model and ten country-level adaptations of the same model. Key assumptions were associated with duration of treatment effect for belimumab plus SOC and extrapolated treatment duration.
Conclusion: Limited economic evaluations of pharmacological treatments for SLE were identified. Future economic models in SLE should meet dual aims of transparency and robustness. Key recommendations include that a lifetime model is essential for handling short and long-term complications of SLE, including organ damage and flares, and whilst the simulation model has been shown to be acceptable, for transparency and ease of interpretation the Markov model could be an acceptable and robust modelling approach.