Email this article Markov's model of decision making on basic therapy of rheumatoid arthritis: monotherapy and its cost
- Authors: Goryachev DV1, Erdes S.F1
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- Issue: Vol 79, No 5 (2004)
- Pages: 35-39
- Section: Editorial
- URL: https://ter-arkhiv.ru/0040-3660/article/view/29822
- ID: 29822
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Abstract
Aim. To design Markov's model of decision making to study the role of order in the use of most usable basic antirheumatic drugs (methotrexate-MT, parenteral gold -PG and sulfasalasine - SS) in terms of the course duration and cost.
Material and methods. The model was based on metaanalysis made in 2000. The program TreeAge 3.0 was used. The prices for the drugs were taken as mean about Moscow for 2002 and prices presented by ACR for 2002.
Results. The sequence MT-PG-SS had the advantage over the other sequences in that less number of patients stopped treatment after 5 and 10 years of therapy. Mean cost of the drugs per patient is the lowest (for five years) if MT is prescribed first. In longer treatment SS-MT-PG is more cost-effective. Conclusion. It is feasible to design Markov's models for making decision on optimal therapy of rheumatoid arthritis both in terms of cost and clinical response.
Material and methods. The model was based on metaanalysis made in 2000. The program TreeAge 3.0 was used. The prices for the drugs were taken as mean about Moscow for 2002 and prices presented by ACR for 2002.
Results. The sequence MT-PG-SS had the advantage over the other sequences in that less number of patients stopped treatment after 5 and 10 years of therapy. Mean cost of the drugs per patient is the lowest (for five years) if MT is prescribed first. In longer treatment SS-MT-PG is more cost-effective. Conclusion. It is feasible to design Markov's models for making decision on optimal therapy of rheumatoid arthritis both in terms of cost and clinical response.
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References
- Augustovski F. A., Cantor S. В., Thach С. Т., Spann S. J. Aspirin for primary prevention of cardiovacular events. J. Gen. Intern. Med. 1998; 13: 824-835.
- Kwok Y. S., Kim С. Medical therapy or coronary artery bypass graft surgery for chronic stable angina: an update using decision analysis. Am. J. Med. 2001; 111 (2): 155-156.
- Lafata J. E., Martin S. A., Kaatz S., Ward R. E. J. The costeffectiveness of different management strategies for patients on chronic warfarin therapy. J. Gen. Intern. Med. 2000; 15 (1): 31-37.
- Verburg R. J., Sont J. K., Vliet Vlieland T. P. et al. High dose chemotherapy followed by autologous peripheral blood stem cell transplantation or conventional pharmacological treatment for refractory rheumatoid arthritis? A Markov decision analysis. J. Rheumatol. 2001; 28 (4): 688-690.
- Wong J. В., Ramey D. R., Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthr. and Rheum. 2001; 44 (12): 2746-2749.
- Albert D. A., Aksentievitch S., Hurst S. et al. Modeling therapeutic strategies in rheumatoid arthritis: use of decision analysis and Markov models. J. Rheumatol. 2000; 27 (3): 644-652.
- Сигидин Я. А., Лукина Г. В. Новые подходы к анализу патогенеза и патогентической терапии ревматоидного артрита. Науч.-практ. ревматол. 2001; 5: 4-11.
- Pavelka К., Forejtova S., Pavelkova A. et al. Analysis of the reasons for DMARD therapy discontinuation in patients with rheumatoid arthritis in the Czech and Slovak Republics. Clin. Rheumatol. 2002; 21 (3): 220-226.
- Swierkot J., Szechinski J., Wiland P. Five year clinical evaluation of treatment efficacy with methotrexate. Pol. Arch. Med. Wewnet. 2000; 103 (5-6): 267-275.
- Maetzel A., Wong A., Strand V. et al. Meta-analysis of treatment termination rates among rheumatoid arthritis patients receiving disease-modifying anti-rheumatic drugs. Rheumatology (Oxford) 2000; 39 (9): 975-981.
- Hilliquin P., Laoussadi S., Menkes С. J. Treatment of rheumatoid polyarthritis with methotrexate. Rev. Rhum. Mai. Osteoartic 1991; 58 (6): 419-426.
- Menninger H., Herborn G., Sander O., Blechschmidt G. A 36 month comparative trial of methotrexate and gold sodium thiomalate in the treatment of early active and erosive rheumatoid arthritis. Br. J. Rheumatol. 1998; 10 (37): 1060-1069.
- Merkesdal S., Ruof J., Mittendorf T. et al. Gesundheitsokonomische Forschung im Bereich der chronischen Polyarthritis. Z. Rheumatol. 2002; 61: 21-29.
- American College of Rheumatlogy Subcommittee on Rheumatoid Arthritis Guidelines. Arthr. and Rheum. 2002; 46 (2): 328-346.
- Wolfe F., Albert D. A., Pincus T. A survey of United States rheumatologists concerning effectiveness of disease-modifying antirheumatic drugs and prednisone in the treatment of rheumatoid arthritis. Arthr. Care Res. 1998; 11: 375-380.
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