The introduction of biological agents into the therapeutic armamentarium for rheumatoid arthritis (RA) has ushered in a new era for rheumatologists in more ways than one. Randomised controlled trials (RCTs) and longitudinal observational studies provide clear evidence that the use of these agents is associated with a greater proportion of responders and a better response than with conventional disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX).^1–9 However, these drugs are substantially more expensive than conventional DMARDs. This means that, whether we like it or not (and most of us don’t like it), cost is now one of the factors we have to consider when selecting treatment for patients with RA. Perhaps for the first time rheumatologists are having to take part in the process of healthcare policy making and endeavour to understand the language of cost effectiveness analysis (CEA). CEA compares the incremental cost of an intervention (in this case anti-tumour necrosis factor α (TNFα) therapy) over the cost of conventional treatment with its incremental health benefit.¹⁰

The paper published in this issue of the Annals by Bansback et al is based on a CEA funded by Abbott Laboratories, the manufacturers of adalimumab, for submission to the Swedish Government.¹¹ It is to be welcomed that the work is published in an academic peer reviewed journal because health economic modelling is as much a legitimate scientific endeavour as the RCTs which led to the drug being licensed.

COST EFFECTIVENESS

The first question posed by healthcare purchasers when …