RESEARCH - Costs of Early RA: a Randomized Comparison of Combined Step-down Prednisolone, MTX, and SSZ with SSZ Alone

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J Rheumatol. 2004 Sep;31(9):1709-16.

Indirect and Total Costs of Early Rheumatoid Arthritis: a Randomized

Comparison of Combined Step-down Prednisolone, Methotrexate, and

Sulfasalazine with Sulfasalazine Alone.

Korthals-De Bos I, Van Tulder M, Boers M, Verhoeven AC, Ader HJ, Bibo J,

Boonen A, Van Der Linden S.

Institute for Research in Extramural Medicine, VU University Medical

Center, Amsterdam, The Netherlands.

OBJECTIVE: To describe the effect of indirect costs for patients with

early rheumatoid arthritis (RA) within the COBRA trial

(Combinatietherapie Bij Reumatoide Artritis) on the cost-effectiveness

of both therapies. Analyses of the efficacy and direct costs of the

treatments have already been reported. METHODS: Patients with early RA

selected for the 56-week trial were randomly assigned to prednisolone,

methotrexate, and sulfasalazine (the COBRA combination) (n = 76, tapered

after 28 weeks) or to sulfasalazine (SSZ; n = 79, of which 78 patients

were evaluable) alone. The main efficacy outcomes were a pooled index

and radiographic damage score in hands and feet, and utilities. Direct

and indirect costs were measured (from a societal perspective) by means

of cost diaries and interviews completed by patients during the

intervention phase and the followup phase, each lasting 28 weeks.

Differences in mean costs between groups and cost-utility ratios were

evaluated by applying nonparametric bootstrapping techniques. RESULTS:

In the first 28 weeks, indirect costs per patient totaled US $2,578 and

US $3,638 for COBRA and SSZ therapy, respectively (p = 0.09). The total

costs were $5,931 and $7,853, respectively (p < 0.05). These differences

were lost in the second 28 weeks. For the total period the mean total

costs per patient were $10,262 and $12,788, respectively (p = 0.11).

Sensitivity analyses showed robustness of the data. The point estimate

of the cost per quality-adjusted life-year based on the rating scale was

negative at $-385, suggesting dominance of COBRA (more effect at lower

cost).

CONCLUSION: COBRA therapy adds additional disease control (improvements

in disease activity, physical function, and rate of damage progression)

at lower or equal cost compared to SSZ in early RA.

PMID: 15338488

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5338488 & dopt=Abstract

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