%0 Journal Article %1 Kravitz2008 %A Kravitz, Richard L %A Duan, Naihua %A White, Richard H %D 2008 %J Archives of internal medicine %K AntirheumaticAgents AntirheumaticAgents:administration&dosage AntirheumaticAgents:economics Arthritis Combination Cost-BenefitAnalysis DecisionTrees DrugTherapy Humans ImmunoglobulinG ImmunoglobulinG:administration&dosage ImmunoglobulinG:economics Methotrexate Methotrexate:administration&dosage Methotrexate:economics Receptors Rheumatoid Rheumatoid:drugtherapy Rheumatoid:economics TreatmentOutcome TumorNecrosisFactor TumorNecrosisFactor:administration&dosage %N 10 %P 1030-3 %R 10.1001/archinte.168.10.1030 %T N-of-1 trials of expensive biological therapies: a third way? %U http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2715700&tool=pmcentrez&rendertype=abstract %V 168 %X In developing policies for use of expensive agents, such as those used for the treatment of rheumatoid arthritis, managed care organizations have invoked "stepped care," in which physicians and patients must first try more established and less costly agents. N-of-1 clinical trials are multiple crossover trials in a single patient. In this cost-minimization analysis, we show that offering patients with rheumatoid arthritis the opportunity to participate in an n-of-1 trial comparing methotrexate with etanercept could save costs relative to open access while preserving clinical freedom relative to mandatory stepped care. In the primary model, the n-of-1 trial option was 15% more expensive than stepped care but 47% cheaper than open access to etanercept. More research is needed on the acceptability, safety, and generalizability of this promising approach. %@ 1538-3679

@article{Kravitz2008, abstract = {In developing policies for use of expensive agents, such as those used for the treatment of rheumatoid arthritis, managed care organizations have invoked "stepped care," in which physicians and patients must first try more established and less costly agents. N-of-1 clinical trials are multiple crossover trials in a single patient. In this cost-minimization analysis, we show that offering patients with rheumatoid arthritis the opportunity to participate in an n-of-1 trial comparing methotrexate with etanercept could save costs relative to open access while preserving clinical freedom relative to mandatory stepped care. In the primary model, the n-of-1 trial option was 15% more expensive than stepped care but 47% cheaper than open access to etanercept. More research is needed on the acceptability, safety, and generalizability of this promising approach.}, added-at = {2023-02-03T11:44:35.000+0100}, author = {Kravitz, Richard L and Duan, Naihua and White, Richard H}, biburl = {https://www.bibsonomy.org/bibtex/2a828e9ba847c7843eca5a2678e38b14a/jepcastel}, city = {Division of General Medicine and Center for Healthcare Policy and Research, University of California, Davis, School of Medicine, Sacramento, CA 95817, USA. rlkravitz@ucdavis.edu}, doi = {10.1001/archinte.168.10.1030}, interhash = {e1229dafdded0b46bf363f9d26f820ad}, intrahash = {a828e9ba847c7843eca5a2678e38b14a}, isbn = {1538-3679}, issn = {1538-3679}, journal = {Archives of internal medicine}, keywords = {AntirheumaticAgents AntirheumaticAgents:administration&dosage AntirheumaticAgents:economics Arthritis Combination Cost-BenefitAnalysis DecisionTrees DrugTherapy Humans ImmunoglobulinG ImmunoglobulinG:administration&dosage ImmunoglobulinG:economics Methotrexate Methotrexate:administration&dosage Methotrexate:economics Receptors Rheumatoid Rheumatoid:drugtherapy Rheumatoid:economics TreatmentOutcome TumorNecrosisFactor TumorNecrosisFactor:administration&dosage}, month = {5}, note = {4634<m:linebreak></m:linebreak>GR: K24 MH72756/MH/NIMH NIH HHS/United States; JID: 0372440; 0 (Antirheumatic Agents); 0 (Immunoglobulin G); 0 (Receptors, Tumor Necrosis Factor); 185243-69-0 (TNFR-Fc fusion protein); 59-05-2 (Methotrexate); ppublish;<m:linebreak></m:linebreak>Tipus d&#039;estudis}, number = 10, pages = {1030-3}, pmid = {18504330}, timestamp = {2023-02-03T11:44:35.000+0100}, title = {N-of-1 trials of expensive biological therapies: a third way?}, url = {http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2715700&tool=pmcentrez&rendertype=abstract}, volume = 168, year = 2008 }