Cost-effectiveness of treatment strategies using combination disease-modifying anti-rheumatic drugs and glucocorticoids in early rheumatoid arthritis

TY - JOUR

T1 - Cost-effectiveness of treatment strategies using combination disease-modifying anti-rheumatic drugs and glucocorticoids in early rheumatoid arthritis

AU - Wailoo, Allan

AU - Hernández Alava, Mónica

AU - Scott, Ian C

AU - Ibrahim, Fowzia

AU - Scott, David L

N1 - © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].

PY - 2014/10

Y1 - 2014/10

N2 - OBJECTIVE: The aim of this study was to estimate the cost-effectiveness of combination DMARDs with short-term glucocorticoids in early active RA using data from the 2-year Combination of Anti-Rheumatic Drugs in Early RA (CARDERA) trial.METHODS: CARDERA enrolled 467 patients with active RA of <24-months duration. All patients received MTX; half received step-down prednisolone and half ciclosporin in a placebo-controlled factorial design. Differences in mean costs and quality-adjusted life-years (QALYs) over 24-months follow-up were estimated using patient-level data from a UK health service perspective and 2011-12 costs.RESULTS: Two-year costs for each treatment strategy showed primary care costs were negligible across all groups. Drug costs were lowest with MTX/ciclosporin and triple therapy. Hospital costs were lowest with MTX/prednisolone and triple therapy. Triple therapy was least costly and most effective; it dominated all other strategies. At positive values for a QALY in the typical UK range (£20 000-30 000) the probability that triple therapy was the most cost-effective strategy was 0.9. Results were robust to methods used to impute missing data.CONCLUSION: Intensive treatment of early RA with triple therapy (two DMARDs and short-term glucocorticoids) is both clinically effective and cost effective.

AB - OBJECTIVE: The aim of this study was to estimate the cost-effectiveness of combination DMARDs with short-term glucocorticoids in early active RA using data from the 2-year Combination of Anti-Rheumatic Drugs in Early RA (CARDERA) trial.METHODS: CARDERA enrolled 467 patients with active RA of <24-months duration. All patients received MTX; half received step-down prednisolone and half ciclosporin in a placebo-controlled factorial design. Differences in mean costs and quality-adjusted life-years (QALYs) over 24-months follow-up were estimated using patient-level data from a UK health service perspective and 2011-12 costs.RESULTS: Two-year costs for each treatment strategy showed primary care costs were negligible across all groups. Drug costs were lowest with MTX/ciclosporin and triple therapy. Hospital costs were lowest with MTX/prednisolone and triple therapy. Triple therapy was least costly and most effective; it dominated all other strategies. At positive values for a QALY in the typical UK range (£20 000-30 000) the probability that triple therapy was the most cost-effective strategy was 0.9. Results were robust to methods used to impute missing data.CONCLUSION: Intensive treatment of early RA with triple therapy (two DMARDs and short-term glucocorticoids) is both clinically effective and cost effective.

KW - Antirheumatic Agents

KW - Arthritis, Rheumatoid

KW - Cost-Benefit Analysis

KW - Cyclosporine

KW - Drug Costs

KW - Drug Therapy, Combination

KW - Female

KW - Glucocorticoids

KW - Humans

KW - Male

KW - Prednisolone

KW - Quality-Adjusted Life Years

KW - Treatment Outcome

U2 - 10.1093/rheumatology/keu039

DO - 10.1093/rheumatology/keu039

M3 - Article

C2 - 24771112

SN - 1462-0324

VL - 53

SP - 1773

EP - 1777

JO - Rheumatology

JF - Rheumatology

IS - 10

ER -