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 potential for recurrence.
A recent phase 2b trial (an early stage trial designed to test whether a treatment provides a beneficial effect) led by Professor Jagdeep Nanchahal at the Kennedy Institute found that a course of four adalimumab injections significantly reduced hardness and size of early-stage Dupuytren's disease nodules. Anti-TNF treatments are commonly used to treat conditions such as rheumatoid arthritis and psoriasis.
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.
The researchers 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 with the £20,000 per QALY gained that the NHS is normally willing to pay.
Lead author, Dr Helen Dakin, University Research Lecturer at Oxford Population Health's Health Economics Research Centre, 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. '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,' said Professor Nanchahal.
The research was funded by the Health Innovation Challenge Fund (Wellcome, Department of Health and Social Care) and 180 Life Sciences. Dr Dakin is part-funded by the National Institute for Health and Care Research Oxford Biomedical Research Centre. The study is published in Bone and Joint Open.
* 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.
