After two and a half years, the NICE RA appraisal has been completed and is available in a handy 92 page FAD. So here’s a summary, yes, in severe disease, if other treatments have failed, if discounts are available and only continued after 6 months if there is a moderate response, and if patients are started on the cheapest drug (including infliximab biosimilars).
Even with all of these provisos, it looks like an ICER of well over £30K per QALY:
“The Committee considered that the most plausible incremental cost-effectiveness ratio (ICER) for biological DMARDs used in severe active rheumatoid arthritis previously treated with methotrexate, was likely to lie between the Assessment Group’s base-case ICER (that is, £41,600 per quality-adjusted life year [QALY] gained) and the Assessment Group’s ICER for the severe group with the fastest Stanford Health Assessment Questionnaire (HAQ) progression (that is, £25,300 per QALY gained).”
The ERG for this appraisal was ScHARR-TAG, with the research team being Matt Stevenson, Rachel Archer, Jon Tosh, Emma Simpson, Emma Everson-Hock, John Stevens, Allan Wailoo, Monica Hernandez, Suzy Paisley and Kath Williams. The work also spawned additional work for the NICE DSU, principally around HAQ progression, by Laura Gibson, Mónica Hernández-Alava and Allan Wailoo.
All documents are available here.