Oxford researchers supported by the Oxford BRC have found that the anti-TNF treatment adalimumab is likely to be a cost-effective treatment for people affected by early-stage Dupuytren’s disease.
Anti-TNF treatments interfere with the action of a protein called tumour necrosis factor (TNF) and are commonly used to treat conditions such as rheumatoid arthritis and psoriasis.
Dupuytren’s disease affects more than 5 million people in the UK. It causes the fingers to irreversibly curl into the palm due to nodules of tissue forming cords under the skin, impairing hand function and quality of life.
There is currently no approved treatment for early-stage disease. All treatments available for late-stage disease have limitations, including the potential for recurrence.
The researchers at Oxford Population Health’s Health Economics Research Centre (HERC) and the Kennedy Institute of Rheumatology conducted a phase 2b trial to test whether the treatment provided a beneficial effect. They found that a course of four adulimumab injections significantly reduced hardness and size of early-stage Dupuytren’s disease nodules.
Based on the results of the Repurposing Anti-TNF for Treating Dupuytren’s Disease (RIDD) trial, the researchers analysed data on costs and quality of life. They extrapolated the trial results using a patient-level simulation model, which estimated the lifetime cost-effectiveness of adalimumab and the value of further research. The model also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded to treatment.
They found that repeated courses of adalimumab are likely to be a cost-effective way to treat progressive early-stage Dupuytren’s disease. The model-based extrapolation showed that, over a lifetime, repeated courses of adalimumab are likely to cost £14,593 per quality-adjusted life-year (QALY*) gained compared with current NHS practice. This would be considered highly cost-effective compared to the £20,000 per QALY gained that the NHS is normally willing to pay.
Lead author, Dr Helen Dakin (pictured left), University Research Lecturer at HERC and an Oxford BRC Senior Research Fellow, said: “Adalimumab is likely to be a cost-effective treatment for progressive early-stage Dupuytren’s disease and additional research is likely to be good value for money.”
The authors estimated that around 2.6 million people in the UK may have progressive early-stage Dupuytren’s disease.
Professor Jagdeep Nanchahal, of the Kennedy Institute of Rheumatology, who led the study, added: “Our phase 2b data show that adalimumab has the potential to transform the management of progressive early-stage Dupuytren’s disease. It is important that the treatment is cost-effective if it is to become available to patients,”
As well as the Oxford BRC, the research was funded by the Health Innovation Challenge Fund (Wellcome, Department of Health and Social Care) and 180 Life Sciences.
* Quality Adjusted Life Years (QALYs) are a standard metric used to compare the cost-effectiveness of different healthcare interventions. One QALY is equivalent to an additional year gained at full health.