Cost-Effectiveness of Early RA Drug Strategies Analyzed

October 5, 2011
RheumatologyNetwork Staff

The Journal of Musculoskeletal Medicine, The Journal of Musculoskeletal Medicine Vol 28 No 10, Volume 28, Issue 10

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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