Abstract：
:Facing increasing health-related costs and limited health care resources, the assessment of cost effectiveness (CE) of medical procedures is also gaining considerable importance in the field of rheumatology. Since high annual therapy costs of 17,000-21,000 Euro are related to the employment of TNF-alpha blocking agents such as etanercept and infliximab (compared to annual costs of 350-5000 Euro of other disease modifying drugs (DMARDs) in the treatment of rheumatoid arthritis (RA)), their CE has become an important issue. The present investigation summarizes economic evaluations of cost and effectiveness of TNF-alpha blocking agents and compares the results to those of traditional DMARD therapies in patients with RA. The implications of these economic results on the further use of TNF-alpha blocking drugs and methodological improvements of their economic evaluation are discussed. The current literature provides evidence for the CE of the combination therapy with methotrexate (MTX), hydroxychloroquine (HCQ), and sulfasalazine (SASP). In comparison to this finding, the use of etanercept and MTX yields much higher costs, although the highest rate of ACR20 responses is achieved by this combination (additional costs of $42,000 per ACR20 response compared to combination of MTX, HCQ, and SASP). Two recent studies show more promising results of about $12,000/QUALY and even cost savings per QUALY administering etanercept and infliximab, respectively. The wide range of the CE ratios is mainly explained by different methodological approaches. Whether the wider employment of TNF-alpha blocking drugs (comprising not only selected patients) proves to be economically effective, remains to be investigated by further economic analyses. In contrast to the initial disappointing results of the comparison of established DMARD therapies and TNF-alpha blocking drugs in terms of CE, recently published data renders evidence that the CE of the TNF-alpha blocking drugs is comparable to other accepted therapies in internal medicine.
journal_name
Z Rheumatoljournal_title
Zeitschrift fur Rheumatologieauthors
Merkesdal S,Ruof Jdoi
10.1007/s00393-002-1207-7keywords:
subject
Has Abstractpub_date
2002-01-01 00:00:00pages
II/29-32eissn
0340-1855issn
1435-1250journal_volume
61 Suppl 2pub_type
杂志文章,评审abstract：:Still's disease covers a range of disorders from systemic juvenile idiopathic arthritis (SJIA) up to adult onset Still's disease (AOSD). The overlapping clinical features suggest that SJIA and AOSD are different manifestations of a phenotypic continuum in different age stages. Still's disease is clinically characteriz...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-020-00779-2
更新日期：2020-09-01 00:00:00
abstract：:Neuro-endocrine immune mechanisms play an important immunomodulatory role for rheumatic diseases as evidenced by long-recognized effects of glucocorticoids, gender, pregnancy, hemiparalysis, and stress on various clinical and epidemiological aspects. Recently, some regulatory pathways have been identified between the ...
journal_title：Zeitschrift fur Rheumatologie
pub_type：
doi：10.1007/s003930200032
更新日期：2002-04-01 00:00:00
abstract：:Progressive multifocal leukoencephalopathy (PML) is a rare but often fatal demyelinating disease of the central nervous system induced by the JC virus. It mainly occurs in immunocompromised patients. Growing interest in rheumatology has arisen from reports of patients with rheumatic diseases suffering from PML. A dire...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-008-0297-2
更新日期：2008-07-01 00:00:00
abstract：:Rheumatoid arthritis (RA) is a chronic inflammatory disease, which is mainly characterized by synovial hyperplasia, pathological immune phenomena and progressive destruction of the affected joints. Various cell types are involved in the pathogenesis of RA including T cells, antigen presenting cells, and endothelial ce...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s003930170030
更新日期：2001-10-01 00:00:00
abstract：:A 74-year-old female patient with rheumatoid arthritis was diagnosed with Pneumocystis jiroveci pneumonia (PcP) following therapy with methotrexate and prednisone. Although bactrim treatment was initiated and PcP was not detected by a control bronchoalveolar lavage, the patient died. The precise cause of death remains...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-005-0019-y
更新日期：2006-02-01 00:00:00
abstract：:This study documents prospectively the Knee Society knee- and function score of 28 patients with rheumatoid arthritis with 34 PFC unconstrained total knee arthroplasties from preoperative values on at yearly intervals. The average follow-up period was 3.4 years (range 2-5.5 y). At last follow-up over 80% of the knees ...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s003930050035
更新日期：1997-07-01 00:00:00
abstract：:Personalized healthcare tries to predict the effectiveness and safety in individual therapeutic approaches by defining individual patient characteristics (biomarkers), while stratification uses diagnostic patterns for groups of patients for prediction of therapeutic response with less adverse reactions caused by the d...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s00393-011-0886-3
更新日期：2013-02-01 00:00:00
abstract：:After approval of TNF and interleukin-1 inhibiting agents for treatment of refractory rheumathoid arthritis, new agents inhibiting interleukin-6 and costimulatory pathways are entering clinical phase I and II trials. Blockade of costimulation by using a CTLA4 immunoglobulin fusion protein (CTLA4Ig), which inhibits the...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-003-0547-2
更新日期：2003-10-01 00:00:00
abstract：:The case of a 36-year old man with Behçet's disease (BS) for 16 years had low back pain and stiffness in the cervical and lumbar spine. He was diagnosed as having ankylosing spondylitis (AS). In this report we wish to emphasize the clinically occult co-existence of AS in BS and revelation of AS after a long time of BS...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s00393-002-0319-4
更新日期：2002-08-01 00:00:00
abstract：:Heavy physical work load is a known determinant of osteoarthritis of the hip, which may account for the high risk observed among farmers. On the other hand, the data on influence of heavy manual work in the pathogenesis of hand osteoarthritis are still controversial. We examined 25 retired farm laborers who strenuousl...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s003930050193
更新日期：1999-12-01 00:00:00
abstract：:In an intraindividual series of investigation consisting of 30 patients with rheumatoid arthritis the effect of gold therapy (Aurothioglucose) has been proved controlling biochemical and clinical parameters. Controls of the function-index by Steinbrocker et al. have shown a significant improvement in comparison with t...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：
更新日期：1975-05-01 00:00:00
abstract：:Monocytes from patients with definite or classical rheumatoid arthritis show a significantly higher release of O2-radicals in the chemiluminescence assay (2925 X 10(3) cpm) than those of healthy volunteers (267 X 10(3) cpm) (p = 0.01). This difference does not appear in a similar test with granulocytes, which in both ...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：
更新日期：1985-01-01 00:00:00
abstract：:For a long time, most of the infectious diseases seemed to have become under control. In particular, vaccinations have contributed to this development. In recent years newly occurring bacterial infections caused by multidrug-resistant pathogens and viral infections, such as the chikungunya virus, influenza epidemics a...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-020-00875-3
更新日期：2020-11-01 00:00:00
abstract：:Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium size arteries that may affect various organs. The clinical appearance is very variable. The most common manifestations are of the skin, the peripheral nervous system presenting as mononeuritis multiplex and the mesenteric and renal blood vessels due to t...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s00393-014-1483-z
更新日期：2014-12-01 00:00:00
abstract：:Autoreactivity plays a major role in the pathogenesis of RA. The rheumatoid factor has been and still is for now more than 50 years the only autoreactivity that is clinically applied in the diagnosis of RA. This well reflects the current way of thinking that a single antigen or a single cause drives an individual into...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s003930170093
更新日期：2001-02-01 00:00:00
abstract：:Childhood onset rheumatic and musculoskeletal diseases often continue into adulthood. These diseases are associated with a high risk of permanent disability and impairment in the quality of life of people affected. Adolescence and young adulthood represent a particular risk phase for an unfavorable long-term outcome. ...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-016-0140-0
更新日期：2016-08-01 00:00:00
abstract：:Cartilage destruction in arthritis and osteoarthritis is linked to aberrant cytokine and growth factor expression in the affected tissues. It becomes clear that the balance of protective and destructive cytokines is more important for the net destruction than the absolute levels of destructive mediators. IL-1 is a key...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s003930050163
更新日期：1999-06-01 00:00:00
abstract：:Fabry's disease is a hereditary lipid storage disease with deposition of ceramides in nearly all tissues. The lipid deposition in the skin and the synovial compartments causes an enlargement of the skin, the joint capsules and the tendon sheaths, which are recognizable by low KV radiography. The bones of the hand main...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：
更新日期：1986-01-01 00:00:00
abstract：:Over the last ten years various biologics have been introduced in the therapy of rheumatic diseases. The most successful approach so far has been the inhibition of TNF alpha, which is able to suppress systemic inflammation in an unprecedented manner. However, the early observation of newly developed antinuclear antibo...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-003-0530-y
更新日期：2003-06-01 00:00:00
abstract：:The antidesoxyribonuclease B reaction shows in persons of all classes of age examined a similar distribution of titres as the antistreptolysin reaction. The anti DNase B titres however are mostly lower than the titres of the antistreptolysin reaction, except in the group of children, 6 to 17 years of age, suffering fr...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：
更新日期：1981-01-01 00:00:00
abstract：:The effect of meloxicam, a new non-steroidal anti-inflammatory drug, on spontaneous osteoarthrosis of the ankle joint in Crl: CDBR rats was investigated. The drug was administered in the feed at doses of 0.4, 0.6 and 0.8 mg/kg/day over a period of 2 years to 50 males and 50 females per dose. 100 male rats and 100 fema...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s003930050017
更新日期：1997-01-01 00:00:00
abstract：:Antibodies to double-stranded DNA (anti-dsDNA, dsDNA-Ab) are frequently found in systemic lupus erythematosus (SLE), especially during active disease and differ with respect to immunoglobulin class and avidity. The detection of anti-dsDNA is one of the diagnostic criteria for SLE according to the American College of R...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s003930050020
更新日期：1997-03-01 00:00:00
abstract：:Since 1978 a 63-year-old woman with rheumatoid arthritis received D-penicillamine (D-PA) in a daily dose of 250-500 mg (mean 300 mg/d). In 1982 the patient complained of diplopia for several days, the ophthalmological and neurological examinations three days later were normal. In July 1983 she developed a myasthenic s...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：
更新日期：1986-05-01 00:00:00
abstract：:The German Rheuma-Liga as the largest patient organisation presents the different ways of informing patients. Patient- education-programs are presented, with a program focussing on social and psychological issues in particular. ...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s00393-003-1212-5
更新日期：2003-01-01 00:00:00
abstract：:Intra-articular injection of corticosteroids is a powerful anti-inflammatory treatment with relatively few side effects. To date no prospective RCT exists on its use in children with oligoarthritis type I. Thus, in January 2000 the Arbeitsgemeinschaft started a multicenter RCT to compare in children with this diagnosi...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1007/s003930050216
更新日期：2000-04-01 00:00:00
abstract：:The Churg-Strauss syndrome is a disorder characterized by hypereosinophilia and systemic vasculitis occurring in patients with asthma and allergic rhinitis. Only few patients are identified as having this syndrome. The three histological criteria are necrotizing vasculitis, tissue infiltration by eosinophils, and extr...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：
更新日期：1988-11-01 00:00:00
abstract：:T-Large Granular Lymphocyte (T-LGL) leukaemia is a rare clonal disease characterized by neutropenia and/or anaemia. Because of its strong association with rheumatoid arthritis (RA), T-LGL leukaemia is an important differential diagnosis to Felty's syndrome. This differentiation might be especially difficult since, in ...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章,评审
doi：10.1007/s00393-005-0013-4
更新日期：2006-09-01 00:00:00
abstract：:Osteoporosis is an age-related systemic disease leading to increased bone fragility. The vertebral bodies of the transitional area between the thoracic and lumbar spine are often involved. A large number of unreported or late-diagnosed fractures have to be assumed. If risk factors such as advanced age or comorbidities...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s00393-010-0739-5
更新日期：2011-01-01 00:00:00
abstract：UNLABELLED:102 patients (pat.) with active erosive rheumatoid arthritis (RA) with a median disease duration of only 14 months without malalignment or deformities entered a randomized study to compare the effects of 15 mg methotrexate (MTX) and 50 mg gold sodium thiomalate (GST) administered intramuscularly once a week....
journal_title：Zeitschrift fur Rheumatologie
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1992-07-01 00:00:00
abstract：:Common variable immunodeficiency (CVID) represents the most common clinically relevant form of primary immunodeficiency. This heterogeneous antibody deficiency syndrome is characterized not only by susceptibility to bacterial respiratory tract infections but displays additional signs of immune dysregulation, such as a...
journal_title：Zeitschrift fur Rheumatologie
pub_type： 杂志文章
doi：10.1007/s00393-013-1162-5
更新日期：2013-09-01 00:00:00
