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

• 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
• ISSN: 0004-3591; 0893-7524; 1529-0131; 1529-0123
• DOI: 10.1002/art.24169

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.