Article Text

OP0094 Cost-Effectiveness of Biologic Versus Conventional Combination Treatment in Early Rheumatoid Arthritis: 2-Year Results of the Randomised Controlled Swefot Trial
  1. J. Eriksson1,
  2. J. A. Karlsson2,
  3. J. Bratt1,
  4. I. F. Petersson2,
  5. R. F. van Vollenhoven1,
  6. S. Ernestam1,
  7. P. Geborek2,
  8. M. Neovius1
  1. 1Karolinska Institutet, Stockholm
  2. 2Lund University, Lund, Sweden


Background Adding infliximab (IFX) or sulfasalazine+hydroxychloroquine (SSZ+HCQ) to methotrexate (MTX) in patients with active, early rheumatoid arthritis (RA), resulted in superior radiographic outcome in the IFX group,[1] while disease-activity, utility and work loss improved in both arms, without detectable between-group differences at 21 months[1-3].

Objectives To evaluate the cost-effectiveness of biologic vs. conventional combination treatment in early RA-patients responding insufficiently to MTX.

Methods This multicenter, randomised, controlled, open-label trial enrolled RA-patients (symptoms<1y) in Sweden between 2002 and 2005. After 3-4 months of MTX monotherapy, patients with a remaining DAS28>3.2 were randomised to addition of IFX or SSZ+HCQ. The incremental cost-effectiveness ratio (ICER=€/quality-adjusted life-year [QALY]) was assessed during 21 months from randomisation. Costs of RA-related medications, non-primary healthcare utilisation and work loss were retrieved from nationwide registers, while EuroQol 5-Dimensions utility was collected quarterly. Undiscounted analyses including all patients were performed from the societal (human capital method) and healthcare perspectives. Confidence intervals were estimated by non-parametric bootstrapping.

Results Of 487 patients initially enrolled, 128 and 130 were randomised to biologic and conventional treatment, respectively. The biologic group had higher drug and healthcare costs (€27,487 vs. 10,364; adjusted mean difference 16,956 [95%CI 14,647;19,162]), while no difference was seen in productivity losses (€33,804 vs. 29,220; 3,961 [-3,986;11,850]), resulting in higher societal cost, as compared to the conventional treatment arm (€61,291 vs. 39,584; 20,916 [12,800;28,660]). Mean accumulated QALYs were 1.10 in the biologic and 1.12 in the conventional treatment group (adjusted mean difference 0.01 [95%CI -0.07;0.08]). The resulting ICER, comparing the biologic to the conventional treatment option, was €2,404,197/QALY from the societal (Figure), and €1,948,919/QALY from the healthcare perspective.

Conclusions In early MTX-refractory RA, the addition of IFX, as compared to addition of SSZ+HCQ, was not cost-effective over 21 months at willingness to pay levels generally considered acceptable.


  1. van Vollenhoven RF, et al. Lancet 2012;379:1712-1720.

  2. Karlsson JA, et al. Ann Rheum Dis 2012. Nov 29 [Epub ahead of print].

  3. Eriksson JK, et al. ACR 2011; Abstract no: 459.


Disclosure of Interest None Declared

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.