Cost-effectiveness research has been developed to assess the balance between the additional costs incurred by a new medication, a new device or a new disease management strategy (incremental costs) and the health benefit associated with the studied innovation (incremental effectiveness).
Such analyses have been extensively used for therapeutic innovation, especially biologics assessment. Despite many methodological concerns, there is a strong agreement in developed countries on the cost-effectiveness at an acceptable value of biologic agents in rheumatoid arthritis (RA) patients with inadequate response to synthetic DMARDs. In early RA, the incremental cost-effectiveness ratio of biologic agents is high compared to synthetic DMARDs, usually above the commonly acceptable thresholds.
To assess the cost-effectiveness of health care organization or patient trajectory is more challenging. Resources, i.e., are available general practitioner (GP) and rheumatologists and their difference in terms of costs is way lower than the difference between synthetic DMARDs and biologics. In terms of access to specialized care, several options have been proposed from clinical practice tools to rapidly refer an early arthritis patient to the rheumatologists up to dedicated early arthritis clinics. In this domain, costs are probably not the main driver for decision makers. Effectiveness of patient trajectory organization is probably more relevant whatever the perspective, i.e., the combination of rapidity of making the adequate diagnosis as well as the simplicity in terms of delay and distance to achieve this.
Disclosure of Interest B. Fautrel Grant/Research support from: AbbVie, MSD, NORDIC Pharma, Pfizer, Consultant for: AbbVie, BMS, MSD, NORDIC, Pfizer, Roche, UCB