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Step-down and intensive combinations of disease-modifying antirheumatic drugs (DMARDs) probably are the most cost-effective strategies for patients with early, active rheumatoid arthritis.
Step-down and intensive combinations of disease-modifying antirheumatic drugs (DMARDs) probably are the most cost-effective strategies for patients with early, active rheumatoid arthritis. The step-down combination strategy appears to be less costly and more effective than DMARD monotherapy.
Tosh and colleagues developed a decision analytic model to estimate the lifetime costs and effects of several treatment strategies. Strategies and their short-term effectiveness were based on randomized controlled trials and observational evidence.
The intensive DMARD combination strategy was the most costly and step-down DMARD combination therapy the least costly. Although DMARD monotherapy was the least expensive strategy in terms of DMARD drug cost, it was not the most cost-effective. The strategies that used intensive or step-down DMARD combinations were the most effective. Monotherapy was found to be more effective over a patient’s lifetime than several of the combination strategies. The corticosteroid plus DMARD monotherapy was both more costly and less effective. Step-up combination and parallel combination therapies were cost-saving but also less effective. Step-down combination therapy exceeded monotherapy and step-up, parallel, and corticosteroid combinations (less costly and more effective).
The authors noted that more cost-effectiveness analyses are needed to extend this work in comparing the use of biologic therapies with DMARD combination strategies.
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