Economic aspects of treatment options in rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 69; no. 6; pp. 995 - 1003
• Main Authors: Schoels, Monika, Wong, John, Scott, David L, Zink, Angela, Richards, Pamela, Landewé, Robert, Smolen, Josef S, Aletaha, Daniel
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2010; BMJ Publishing Group; Elsevier Limited
• Subjects: Antirheumatic Agents - economics; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - economics; Biological and medical sciences; Cost analysis; Cost-Benefit Analysis; Disease; Diseases of the osteoarticular system; Drug Costs - statistics & numerical data; Editorials; Evidence-Based Medicine - methods; Funding; Humans; Inflammatory joint diseases; Literature reviews; Medical sciences; Medical Subject Headings-MeSH; Pharmaceutical industry; Practice Guidelines as Topic; Productivity; Quality; Rheumatoid arthritis; Studies; Treatment Failure; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Immunopathology; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Review; Epidemiology; Recommendation; Chronic; Treatment; Health economy; Rheumatoid arthritis; Economic aspect; Public health; Bibliographic review
• ISSN: 0003-4967; 1468-2060; 1468-2060
• DOI: 10.1136/ard.2009.126714

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.