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

Allan Wailoo, Mónica Hernández Alava, Ian C Scott, Fowzia Ibrahim, David L Scott

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1773-1777
Number of pages5
JournalRheumatology
Volume53
Issue number10
DOIs
Publication statusPublished - Oct 2014

Keywords

  • Antirheumatic Agents
  • Arthritis, Rheumatoid
  • Cost-Benefit Analysis
  • Cyclosporine
  • Drug Costs
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids
  • Humans
  • Male
  • Prednisolone
  • Quality-Adjusted Life Years
  • Treatment Outcome

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