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It is impossible to ignore: costs and budget considerations increasingly influence the way rheumatologists can treat and care for their patients in clinical practice. This is especially the case for biologics in the treatment of patients with inflammatory rheumatologic diseases. Until 15 years ago, drug reimbursement decisions in rheumatology were mainly influenced by data on effectiveness and safety. Costs and pricing were a minor issue. This changed somewhat when cyclooxygenase II selective nonsteroidal antiinflammatory drugs were marketed. However, with the introduction of the biologic disease-modifying antirheumatic drugs (DMARD) in rheumatology, the balance between clinical effectiveness and economic aspects of decision options, assessed using cost-effectiveness analyses, played an essential role in reimbursement decisions. This resulted in mounting debates among rheumatologists, and many became involved in negotiations with their hospitals or health insurance companies on how to afford treatments with these drugs within existing budgets. Cost and cost-effectiveness considerations are nowadays also taken into account in treatment recommendations. In the American College of Rheumatology (ACR) recommendations of 2008 on the use of biologic and nonbiologic DMARD in rheumatoid arthritis (RA), the “role of costs for treatment with biologic DMARD” was one of the 5 domains of the literature search that addressed the scientific evidence1. Along the same lines, the role of biologics in the European League Against Rheumatism (EULAR) recommendations for the management of RA with synthetic and biological DMARD2 is supported by a literature over view on cost-effectiveness of biologics, published separately3.While the clinical position of biologic DMARD in early DMARD-naive patients in terms of effectiveness, safety, and preferences remains an issue for further studies, the above mentioned EULAR overview3, as well as a more recent systematic review on cost-effectiveness of biologic DMARD in RA4, conclude that it is unlikely that … Address correspondence to Dr. Boonen; E-mail: a.boonen{at}mumc.nl

Evaluating Treatment Strategies in Patients with Early Rheumatoid Arthritis: Merging Modeling Theory with Clinical Practice