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Economic aspects of treatment options in rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis
  1. Monika Schoels1,2,
  2. John Wong2,
  3. David L Scott3,
  4. Angela Zink4,
  5. Pamela Richards5,
  6. Robert Landewé6,
  7. Josef S Smolen1,7,
  8. Daniel Aletaha7
  1. 12nd Department of Internal Medicine, Hietzing Hospital, Vienna, Austria
  2. 2Division of Clinical Decision Making, Informatics and Telemedicine, Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3King's College School of Medicine, Weston Education Centre, London, UK
  4. 4German Rheumatism Research Centre and Charité University Medicine, Berlin, Germany
  5. 5University of Bristol, Academic Rheumatology Unit, Bristol Royal Infirmary, Bristol, UK
  6. 6Department of Internal Medicine/Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  7. 7Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Austria
  1. Correspondence to Dr Monika Schoels, 2nd Department of Internal Medicine, Hietzing Hospital, Wolkersbergenstraße 1, 1130 Vienna, Austria; monika.schoels{at}


Objective To review the cost effectiveness of rheumatoid arthritis (RA) treatments and inform the clinical recommendations by the European League Against Rheumatism.

Methods A systematic literature search and review of the health economic evidence on RA treatment options was performed.

Results Despite diverse methodological approaches, health economic analyses are concordant: at onset of disease, traditional disease-modifying antirheumatic drugs (DMARDs) are cost effective—that is, treatment merits outweigh treatment costs. If DMARDs fail, therapeutic escalation with tumour necrosis factor α inhibitors (TNFi) is cost effective when standard dosing schemes are employed. If TNFi fail, rituximab or abatacept is cost effective. Economic evidence for switching TNFi remains sparse.

Conclusions The costly sequelae of insufficiently controlled RA justify intensive escalations of treatment in this disease. By maintaining function, patients are kept in the work process, reducing indirect costs. Quality of life is improved at an expense commonly accepted for chronic diseases. Effective control of disease activity seems to be a prudent use of societal resources.

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  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Competing interests None. Francis Berenbaum was the Handling Editor.