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Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthritis

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Abstract

The objective was to assess the cost-effectiveness of various DMARDs compared with antimalarials (AM) for rheumatoid arthritis (RA) treatment. The data on disease activity, functional status and societal costs were collected from a 1-year cohort of 152 patients with RA receiving at least one DMARD for ≥ 6 months. Incremental cost effectiveness ratio (ICER) was calculated from the societal costs of DMARD treatment compared with AM per one unit of HAQ improvement. All costs were presented in 2001 US dollars. Mean (SD) societal cost of AM treatment was US$ 2,285 (1,154) per patient per year. MTX + AM was less costly and more effective than AM, as the ICER of this combination would save US$ 834 per 1 U of HAQ improvement. MTX + SSZ, leflunomide, and triple therapy (AM + MTX + SSZ) were more effective than AM with additional costs. RA treatment with non MTX-based DMARDs was not cost-effective.

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References

  1. Kvien TK (2004) Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics 22(suppl 1):1–12

    PubMed  Google Scholar 

  2. Meenan RF, Yelin EH, Henke CJ et al (1978) The costs of rheumatoid arthritis. A patient-oriented study of chronic disease costs. Arthritis Rheum 21:827–833

    Article  PubMed  CAS  Google Scholar 

  3. Meenan RF, Yelin EH, Nevitt M, Epstein WV (1981) The impact of chronic disease. A sociomedical profile of rheumatoid arthritis. Arthritis Rheum 24:544–549

    Article  PubMed  CAS  Google Scholar 

  4. Lubeck DP, Spitz PW, Fries JF et al (1986) A multicenter study of annual health service utilization and costs in rheumatoid arthritis. Arthritis Rheum 29:488–493

    Article  PubMed  CAS  Google Scholar 

  5. van Jaarsveld CH, Jacobs JW, Schrijvers AJ et al (1998) Effects of rheumatoid arthritis on employment and social participation during the first years of disease in the Netherlands. Br J Rheumatol 37:848–853

    Article  PubMed  Google Scholar 

  6. Yelin E, Wanke LA (1999) An assessment of the annual and long-term direct costs of rheumatoid arthritis. The impact of poor function and functional decline. Arthritis Rheum 42:1209–1218

    Article  PubMed  CAS  Google Scholar 

  7. Michaud K, Messer J, Choi HK, Wolfe F (2003) Direct medical costs and their predictors in patients with rheumatoid arthritis. Arthritis Rheum 48:2750–2762

    Article  PubMed  Google Scholar 

  8. Merkesdal S, Ruof J, Schoffski O et al (2001) Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthritis Rheum 44:528–534

    Article  PubMed  CAS  Google Scholar 

  9. Lajas C, Abasolo L, Bellajdel B et al (2003) Costs and predictors of costs in rheumatoid arthritis: a prevalence-based study. Arthritis Rheum 49:64–70

    Article  PubMed  Google Scholar 

  10. Pugner KM, Scott DI, Holmes JW, Hieke K (2000) The costs of rheumatoid arthritis: an international long-term view. Semin Arthritis Rheum 29:305–320

    Article  PubMed  CAS  Google Scholar 

  11. Cooper NJ (2000) Economic burden of rheumatoid arthritis: a systematic review. Rheumatology 39:28–33

    Article  PubMed  CAS  Google Scholar 

  12. Suarez-Almazor ME, Osiri M, Emery P, Ottawa Methods Group (2004) Rheumatoid arthritis. In: Tugwell P, Shea B, Boers M et al (eds) Evidence-based rheumatology. BMJ Publishing Group, London, pp 243–282

    Google Scholar 

  13. Gabriel SE, Coyle D, Moreland LW (2001) A clinical and economic review of disease-modifying antirheumatic drugs. Pharmacoeconomics 19:715–728

    Article  PubMed  CAS  Google Scholar 

  14. Thompson MS, Read JL, Hutchings HC et al (1988) The cost effectiveness of auranofin: results of a randomized clinical trial. J Rheumatol 15:35–42

    PubMed  CAS  Google Scholar 

  15. Borg G, Allander E, Goobar JE (1990) Disease-modifying antirheumatic drug therapy: an expensive therapy despite inexpensive drugs. Scand J Rheumatol 19:115–121

    PubMed  CAS  Google Scholar 

  16. Prashker MJ, Meenan RF (1995) The total costs of drug therapy for rheumatoid arthritis. Arthritis Rheum 38:318–325

    Article  PubMed  CAS  Google Scholar 

  17. Kavanaugh A, Heudebert G, Cush J, Jain R (1996) Cost evaluation of novel therapeutics in rheumatoid arthritis (CENTRA): a decision analysis model. Semin Arthritis Rheum 25:297–307

    Article  PubMed  CAS  Google Scholar 

  18. Anis AH, Tugwell PX, Wells GA, Stewart DG (1996) A cost effectiveness analysis of cyclosporine in rheumatoid arthritis. J Rheumatol 23:609–613

    PubMed  CAS  Google Scholar 

  19. Verhoeven AC, Bibo JC, Boers M et al (1998) Cost-effectiveness and cost-utility of combination therapy in early rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone. Br J Rheumatol 37:1102–1109

    Article  PubMed  CAS  Google Scholar 

  20. Choi HK, Seeger JD, Kuntz KM (2000) A cost-effectiveness analysis of treatment options for methotrexate-resistant rheumatoid arthritis. Arthritis Rheum 43:2316–2327

    Article  PubMed  CAS  Google Scholar 

  21. Maetzel A, Strand V, Tugwell P et al (2002) Economic comparison of leflunomide and methotrexate in patients with rheumatoid arthritis: an evaluation based on a 1-year randomized controlled trial. Pharmacoeconomics 20:61–70

    Article  PubMed  CAS  Google Scholar 

  22. Maetzel A, Strand V, Tugwell P et al (2002) Cost effectiveness of adding leflunomide to a 5-year strategy of conventional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis. Arthritis Rheum 47:655–661

    Article  PubMed  Google Scholar 

  23. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:15–24

    Article  Google Scholar 

  24. Osiri M, Deesomchok U, Tugwell P (2001) Evaluation of functional ability of Thai patients with rheumatoid arthritis by the use of a Thai version of the health assessment questionnaire. Rheumatology 40:555–558

    Article  PubMed  CAS  Google Scholar 

  25. Fries JF, Spitz P, Kraines RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145

    Article  PubMed  CAS  Google Scholar 

  26. Heston A, Summers R, Aten B (2002) Penn World Table version 6.1. Center for International Comparisons at the University of Pennsylvania (CICUP). <http://pwt.econ.upenn.edu>

  27. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines (2002) Guidelines for the management of rheumatoid arthritis: 2002 update Arthritis Rheum 46:328–346

    Article  Google Scholar 

  28. Carmichael SJ, Beal J, Day RO, Tett SE (2002) Combination therapy with methotrexate and hydroxychloroquine for rheumatoid arthritis increases exposure to methotrexate. J Rheumatol 29:2077–2083

    PubMed  CAS  Google Scholar 

  29. O’Dell JR, Haire CE, Erikson N et al (1996) Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. N Engl J Med 334:1287–1291

    Article  PubMed  CAS  Google Scholar 

  30. O’Dell JR, Haire CE, Erikson N et al (1996) Efficacy of triple DMARD therapy in patients with RA with suboptimal response to methotrexate. J Rheumatol 23(Suppl 44):72–74

    Google Scholar 

  31. O’Dell J, Paulsen G, Haire C et al (1998) Combination DMARD therapy with methotrexate-sulfasalazine-hydroxychlo-roquine in rheumatoid arthritis: continued efficacy with minimal toxicity at 5 years (abstract). Arthritis Rheum 41(Suppl 9):S132

    Google Scholar 

  32. O’Dell JR, Leff R, Paulsen G et al (2002) Treatment of rheumatoid arthritis with methotrexate and hydroxychloroquine, methotrexate and sulfasalazine, or a combination of the three medications: results of a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 46:1164–1170

    Article  PubMed  CAS  Google Scholar 

  33. Kobelt G, Jonsson L, Young A, Eberhardt K (2003) The cost-effectiveness of infliximab (Remicade) in the treatment of rheumatoid arthritis in Sweden and the United Kingdom based on the ATTRACT study. Rheumatology 42: 326–335

    Article  PubMed  CAS  Google Scholar 

  34. Welsing PM, Severens JL, Hartman M et al (2004) Modeling the 5-year cost effectiveness of treatment strategies including tumor necrosis factor-blocking agents and leflunomide for treating rheumatoid arthritis in the Netherlands. Arthritis Rheum 51:964–973

    Article  PubMed  Google Scholar 

  35. Brennan A, Bansback N, Reynolds A, Conway P (2004) Modeling the cost-effectiveness of etanercept in adults with rheumatoid arthritis in the UK. Rheumatology 43:62–72

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. The authors would like to thank Ms. Youwanuch Kaewkum for collecting the data; Ms. Sureerat Ngamkiatpaisan for providing the unit cost data of King Chulalongkorn Memorial Hospital; Dr. May M. Boggess, Dr. Somrat Lertmaharit, and Dr. Saowalak Hunnangkul for calculating bootstrap estimates by Stata software.

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Correspondence to Manathip Osiri.

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Osiri, M., Kamolratanakul, P., Maetzel, A. et al. Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthritis. Rheumatol Int 27, 1063–1069 (2007). https://doi.org/10.1007/s00296-007-0342-5

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  • DOI: https://doi.org/10.1007/s00296-007-0342-5

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