842 Russell measures of HR-QOL were reported in patients in QOL are related to recovery of functional status. the abatacept group than in patients of similar dis However,improvements in mental components of t on the (DAS the HR-QOL ee reported eed in cli 一e yy出 of QOL in sed need for evaluation of the response in HR-OOL with the other biological DMARDs.Such evaluation of HR- HAO-DI score),but failed to reach the same im- QOL should not be limited to clinical trials,but should be expanded into clinical practice.Such ex- In contrast,participants with low pansion will be useful not only to monitor treatment baseline severity showed marked (i.e.seven gmoo”on the burden s the rate change of the continuc us DAS28 scores analysed,similar results were observed,suggesting 6.Economic Implications of QOL in RA that more profound improvements in QOL may be abatacept RA is a chronic In the assess ase and patients of fac rs besides drug better nsts include those related ed thar acquisition costs.Th s with a fav to productivity as well as functional status and per and fewe s the ceived QOL,on which it is more difficult to put a placebo-treated group for seven of the eight SF-36 monetary value.Economic analyses such as cost scales and the physical component effectiveness analyses,which generally compare the summary costs and outcomes of two therapeutic interventions score. 61 Results showed an increased chance(near ly 2:I on most scales)of improving and less chance worsening when a patien costs tha may depend on the al change perspective being evaluated (ie.the pat r or society as a whole) that aba ater it ments in OOL from baseline thro out the entire study than placebo-treated patients In addition. Te the rate of improvement in hr-ooL measures was faster in the abatacept group;therefore,the authors option. the goa er a nev the methods used and the costs that are included. 5.7 Summary of Health-Related QOl The results of cost-effectiveness analyses are re. The above data clearly demonstrate that the effi- ported as an incremental cost-effectiveness ratio cacy of biological DMARDs is not limited to symp- (ICER),which is calculated based on the incremen- tomatic and clinical effects,but that these agents tal (Le.additional)costs of an intervention com measured by. for the treat842 Russell measures of HR-QOL were reported in patients in QOL are related to recovery of functional status. the abatacept group than in patients of similar dis- However, improvements in mental components of ease severity in the placebo group. Patients with the HR-QOL assessment instruments have also been most severe disease at baseline (DAS28 score reported with some of these therapies. HR-QOL has ≥7.59) showed improvement on the most sensitive been most consistently evaluated in clinical trials of measures of QOL improvement (i.e. physical func- abatacept, suggesting there is an increased need for tion, role physical, bodily pain, vitality and pysical evaluation of the response in HR-QOL with the component summary score of the SF-36 and the other biological DMARDs. Such evaluation of HR￾HAQ-DI score), but failed to reach the same im- QOL should not be limited to clinical trials, but provements as those observed for the entire patient should be expanded into clinical practice. Such ex￾population.[76] In contrast, participants with low pansion will be useful not only to monitor treatment baseline severity showed marked improvements response for patient-centred outcomes, but also to from baseline in most measures of QOL (i.e. seven provide additional information on the burden of of the eight SF-36 subscales, HAQ score and fatigue disease and the effectiveness of these agents in measures) when treated with abatacept.[76] When the reducing this burden in the real-world setting. rate change of the continuous DAS28 scores was analysed, similar results were observed, suggesting 6. Economic Implications of QOL in RA that more profound improvements in QOL may be observed when patients are treated with abatacept Because RA is a chronic disease and patients early in the course of their disease.[76] In the assess- receive lifelong treatment, overall costs of treatment ment of the number of people in each of the catego- are influenced by a variety of factors besides drug ries of change from baseline (i.e. better, same or acquisition costs. These costs include those related worse), results indicated that the abatacept-treated to productivity as well as functional status and per- group had significantly more patients with a favou- ceived QOL, on which it is more difficult to put a rable change and fewer with worse QOL versus the monetary value. Economic analyses such as cost- placebo-treated group for seven of the eight SF-36 effectiveness analyses, which generally compare the scales and the physical component summary costs and outcomes of two therapeutic interventions, score.[76] Results showed an increased chance (near- can be useful for providing a specific perspective on ly 2 : 1 on most scales) of improving and less chance the costs that may be associated with a particular of worsening when a patient is treated with treatment. The costs included in such analyses may abatacept compared with traditional DMARDs depend on the perspective being evaluated (i.e. the alone.[76] Analyses of differential change over time patient, the payer or society as a whole). for the HAQ, SF-36, and fatigue measures indicated Ideally the pharmacoeconomic evaluation of that abatacept-treated patients had greater improve- therapy should include both direct and indirect ments in QOL from baseline throughout the entire costs. The best possible option is found by weighing study than placebo-treated patients.[76] In addition, the total expected costs against the total expected the rate of improvement in HR-QOL measures was benefits for each option. While the goal of cost- faster in the abatacept group; therefore, the authors effectiveness analysis is to determine whether a new suggested that this may increase the likelihood of intervention is economically justified compared patient adherence to treatment in clinical practice.[76] with a given alternative, it is important to consider the methods used and the costs that are included. 5.7 Summary of Health-Related QOL The results of cost-effectiveness analyses are re￾The above data clearly demonstrate that the effi- ported as an incremental cost-effectiveness ratio cacy of biological DMARDs is not limited to symp- (ICER), which is calculated based on the incremen￾tomatic and clinical effects, but that these agents tal (i.e. additional) costs of an intervention com￾result in clinically meaningful benefits for outcomes pared with alternative therapy, divided by the incre￾of importance to, and measured by, the patients mental (i.e. additional) benefits obtained.[43] With themselves. Most of these positive effects on HR- the emergence of biological DMARDs for the treat- © 2008 Adis Data Information BV. All rights reserved. Pharmacoeconomics 2008; 26 (10)