Cost‐utility analysis of treatment strategies in patients with recent‐onset rheumatoid arthritis

Objective To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA). Methods Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination th...

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Published in:Arthritis and rheumatism 2009-03, Vol.61 (3), p.291-299
Main Authors: Van den Hout, Wilbert B., Goekoop‐Ruiterman, Yvonne P. M., Allaart, Cornelia F., De Vries‐Bouwstra, Jeska K., M. Hazes, J. Mieke, Kerstens, Pit J. S. M., Van Zeben, Derkjen, Hulsmans, Harry M. J., De Jonge‐Bok, Johanna M., De Sonnaville, Peter B. J., Dijkmans, Ben A. C., Breedveld, Ferdinand C.
Format: Article
Language:English
Subjects:
Adult
Aged
Antibodies, Monoclonal - administration & dosage
Antirheumatic Agents - administration & dosage
Antirheumatic Agents - economics
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - economics
Biological and medical sciences
Cost-Benefit Analysis
Diseases of the osteoarticular system
Drug Administration Schedule
Drug Therapy, Combination
Female
Health Care Costs
Humans
Inflammatory joint diseases
Infliximab
Male
Medical sciences
Middle Aged
Prednisone - administration & dosage
Quality-Adjusted Life Years
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Summary:Objective To evaluate societal costs and quality‐adjusted life years (QALYs) of treatment strategies for patients with recent‐onset active rheumatoid arthritis (RA). Methods Patients (n = 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step‐up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures. Results Average QALYs (ideally 2.00) for groups 1–4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P ≤ 0.05 for group 4 versus groups 1–3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P ≤ 0.05 for group 4 versus groups 1–3). The Time Trade‐Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost‐utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs. Conclusion Initial combination therapy with infliximab for patients with recent‐onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions.
ISSN:0004-3591
0893-7524
1529-0131
1529-0123
DOI:10.1002/art.24169