Table 5

Final results

Level of Evidence*
1a1b1c2a2b2c3a3b45Grade of recommendation*
There is evidence of cost effectiveness for intensive treatment, but the available data are limited (no CEAs)70;72; 73;74B
In DMARD naïve patients, MTX*, LEF and SSZ* have been shown to be cost effective1520;21*; 22B
No data about the cost effectiveness of glucocorticoid treatment are available, but they are quite inexpensive (although long-term consequences may be potentially very expensive)xD
TNFi therapy after DMARD failure appears to be cost effective28;40;4139;42–44;46–49B
RTX and ABA appear to be cost effective after TNFi failure60;64B
Combination therapy including biological agents in DMARD naïve patients may not be cost effective compared with MTX monotherapy29A
  • Quality assessment according to the Oxford EBM level of evidence classification.13

  • * MTX or SSZ;

  • LEF. NB.

  • ABA, abatacept; CEAs, cost-effectiveness analyses; DMARD, disease-modifying antirheumatic drug; LEF, leflunomide; MTX, methotrexate; RTX, rituximab; SSZ, sulfasalazine; TNFi, TNFα-inhibitors.