Economic evaluation of folate supplementation during methotrexate treatment in RA

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J Rheumatol. 2004 May;31(5):902-8.

Economic evaluation of folate supplementation during methotrexate

treatment in rheumatoid arthritis.

Hartman M, Van Ede A, Severens JL, Laan RF, Van De Putte L, Van Der Wilt

GJ.

Department of Medical Technology Assessment, University Medical Centre,

Nijmegen, The Netherlands.

OBJECTIVE: To determine cost-effectiveness of folic or folinic acid

supplementation in patients with rheumatoid arthritis (RA) who started

methotrexate (MTX) treatment. METHODS: An economic evaluation, performed

alongside a randomized, double blind, placebo controlled trial with

followup of 48 weeks. Patients started MTX with placebo (n = 137), folic

acid (n = 133), or folinic acid (n = 141). Outcome measures were drug

survival and quality-adjusted life-years (QALY), measured with the

EuroQol questionnaire. Both medical and nonmedical costs were analyzed.

RESULTS: Drug survival after 48 weeks was 60% for placebo, 81% for folic

acid, and 87% for folinic acid. QALY during a 48 week period were 0.55

(95% CI 0.52-0.58) in the placebo group, 0.55 (95% CI 0.52-0.58) in the

folic acid group, and 0.58 (95% CI 0.56-0.60) in the folinic acid group.

Mean medical costs were US$1398 (placebo), US$1409 (folic acid), and

US$1776 (folinic acid). Mean total costs were US$3339, US$3632, and

US$3296, respectively.

CONCLUSION: In terms of resource deployment, no statistically

significant difference was found between the 3 strategies. The preferred

strategy consists of folic acid supplementation because of improved drug

survival.

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