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Cost‐Effectiveness of Combination Disease‐Modifying Antirheumatic Drugs Versus Tumor Necrosis Factor Inhibitors in Active Rheumatoid Arthritis: A Pragmatic, Randomized, Multicenter Trial
Author(s) -
Patel Anita,
Heslin Margaret,
Scott David L.,
Stringer Dominic,
Birrell Fraser,
Ibrahim Fowzia
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23830
Subject(s) - medicine , rheumatoid arthritis , rheumatology , physical therapy , randomized controlled trial , quality of life (healthcare) , confidence interval , indirect costs , methotrexate , quality adjusted life year , cost effectiveness , risk analysis (engineering) , nursing , accounting , business
Objective To determine whether intensive combinations of conventional synthetic disease‐modifying antirheumatic drugs (cs DMARDS ) achieve similar clinical benefits more cheaply than high‐cost biologics such as tumor necrosis factor inhibitors ( TNF i) in patients with active rheumatoid arthritis ( RA ) whose illness has failed to respond to methotrexate and another DMARD . Methods We used within‐trial cost‐effectiveness and cost‐utility analyses from health and social care and 2 societal perspectives. Participants were recruited into an open‐label, 12‐month, pragmatic, randomized, multicenter, 2‐arm, noninferiority trial in 24 rheumatology clinics in England and Wales. Costs were linked with the Health Assessment Questionnaire ( HAQ ; primary outcome) and quality‐adjusted life years derived from 2 measures (Short‐Form 36 health survey and EuroQol 5‐domain 3‐level instrument). Results In total, 205 participants were recruited, 104 in the cs DMARD arm and 101 in the TNF i arm. Participants in the cs DMARD arm with poor response at 6 months were offered TNF i; 46 participants (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6‐month follow‐up and for 91–92% of participants at 12‐month follow‐up. The cs DMARD arm had significantly lower total costs from all perspectives (6‐month health and social care adjusted mean difference –£3,615 [95% confidence interval (95% CI ) –4,104, –3,182]; 12‐month health and social care adjusted mean difference –£1,930 [95% CI –2,599, –1,301]). The HAQ score showed benefit to the cs DMARD arm at 12 months (–0.16 [95% CI –0.32, –0.01]); other outcomes/follow‐ups showed no differences. Conclusion Starting treatment with cs DMARD s, rather than TNF i, achieves similar outcomes at significantly lower costs. Patients with active RA and who meet the National Institute for Health and Care Excellence criteria for expensive biologics can be treated with combinations of intensive cs DMARD s in a cost‐effective manner.