RESEARCH - Aiming at remission in early RA: starting with MTX monotherapy is cost-effective

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Rheumatology (Oxford). 2011 Mar 2. [Epub ahead of print]

Treatment strategies aiming at remission in early rheumatoid arthritis

patients: starting with methotrexate monotherapy is cost-effective.

Schipper LG, Kievit W, den Broeder AA, van der Laar MA, Adang EM,

Fransen J, van Riel PL.

Department of Rheumatology, Radboud University Nijmegen Medical

Centre, Department of Rheumatology, Sint Maartenskliniek Nijmegen,

Nijmegen, Department of Rheumatology, Medisch Spectrum Twente and

University Twente, Enschede and Department of Epidemiology,

Biostatistics and HTA, Radboud University Nijmegen Medical Centre,

Nijmegen, The Netherlands.

Abstract

Objective. To perform a modelling study on the cost-effectiveness of

three outcome-directed strategies in early RA patients: Strategy 1:

starting MTX monotherapy, followed by the addition of LEF, followed by

MTX with addition of anti-TNF; Strategy 2: start with MTX and LEF

combination followed by MTX with anti-TNF; and Strategy 3: immediate

start with MTX and anti-TNF.

Methods. A validated Markov model was used to evaluate the

cost-effectiveness of the three strategies. Effectiveness of the

strategies was determined using daily practice data from two cohorts

and used as input parameter in the model. Patients treated according

to the strategies were matched for baseline 28-joint DAS (DAS-28).

Using Monte Carlo simulation, expected costs, quality-adjusted

life-years (QALYs) and incremental cost per QALY gained for a 5-year

time horizon were calculated following both a health-care and a

societal perspective.

Results. The percentage of patients in remission and number of QALYs

were comparable between the three strategies. Starting with a

combination (MTX plus LEF or anti-TNF) was more costly than starting

with MTX alone. This resulted in an unfavourable incremental

cost-effectiveness ratio for starting on anti-TNF vs initially MTX:

health-care perspective of €138 028 and from a societal perspective of

€136 150 per QALY gained over 5 years.

Conclusion. In this modelling study, starting with MTX or anti-TNF has

comparable effectiveness. However, initial anti-TNF was far more

expensive than starting with MTX monotherapy. Therefore, based on this

study, a treatment strategy starting with MTX monotherapy is favoured

over a strategy with MTX and anti-TNF right away in early RA patients.

PMID: 21371999

http://www.ncbi.nlm.nih.gov/pubmed/21371999

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