Rheumatology International

, Volume 27, Issue 11, pp 1063–1069

Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthritis

  • Manathip Osiri
  • Pirom Kamolratanakul
  • Andreas Maetzel
  • Peter Tugwell
Original Article

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.

Keywords

Rheumatoid arthritis Cost effectiveness analysis Disease modifying antirheumatic drugs Health assessment questionnaire 

References

  1. 1.
    Kvien TK (2004) Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics 22(suppl 1):1–12PubMedGoogle Scholar
  2. 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 21:827–833PubMedCrossRefGoogle Scholar
  3. 3.
    Meenan RF, Yelin EH, Nevitt M, Epstein WV (1981) The impact of chronic disease. A sociomedical profile of rheumatoid arthritis. Arthritis Rheum 24:544–549PubMedCrossRefGoogle Scholar
  4. 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 29:488–493PubMedCrossRefGoogle Scholar
  5. 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 37:848–853PubMedCrossRefGoogle Scholar
  6. 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 42:1209–1218PubMedCrossRefGoogle Scholar
  7. 7.
    Michaud K, Messer J, Choi HK, Wolfe F (2003) Direct medical costs and their predictors in patients with rheumatoid arthritis. Arthritis Rheum 48:2750–2762PubMedCrossRefGoogle Scholar
  8. 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 44:528–534PubMedCrossRefGoogle Scholar
  9. 9.
    Lajas C, Abasolo L, Bellajdel B et al (2003) Costs and predictors of costs in rheumatoid arthritis: a prevalence-based study. Arthritis Rheum 49:64–70PubMedCrossRefGoogle Scholar
  10. 10.
    Pugner KM, Scott DI, Holmes JW, Hieke K (2000) The costs of rheumatoid arthritis: an international long-term view. Semin Arthritis Rheum 29:305–320PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper NJ (2000) Economic burden of rheumatoid arthritis: a systematic review. Rheumatology 39:28–33PubMedCrossRefGoogle Scholar
  12. 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 243–282Google Scholar
  13. 13.
    Gabriel SE, Coyle D, Moreland LW (2001) A clinical and economic review of disease-modifying antirheumatic drugs. Pharmacoeconomics 19:715–728PubMedCrossRefGoogle Scholar
  14. 14.
    Thompson MS, Read JL, Hutchings HC et al (1988) The cost effectiveness of auranofin: results of a randomized clinical trial. J Rheumatol 15:35–42PubMedGoogle Scholar
  15. 15.
    Borg G, Allander E, Goobar JE (1990) Disease-modifying antirheumatic drug therapy: an expensive therapy despite inexpensive drugs. Scand J Rheumatol 19:115–121PubMedGoogle Scholar
  16. 16.
    Prashker MJ, Meenan RF (1995) The total costs of drug therapy for rheumatoid arthritis. Arthritis Rheum 38:318–325PubMedCrossRefGoogle Scholar
  17. 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 25:297–307PubMedCrossRefGoogle Scholar
  18. 18.
    Anis AH, Tugwell PX, Wells GA, Stewart DG (1996) A cost effectiveness analysis of cyclosporine in rheumatoid arthritis. J Rheumatol 23:609–613PubMedGoogle Scholar
  19. 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 37:1102–1109PubMedCrossRefGoogle Scholar
  20. 20.
    Choi HK, Seeger JD, Kuntz KM (2000) A cost-effectiveness analysis of treatment options for methotrexate-resistant rheumatoid arthritis. Arthritis Rheum 43:2316–2327PubMedCrossRefGoogle Scholar
  21. 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 20:61–70PubMedCrossRefGoogle Scholar
  22. 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 47:655–661PubMedCrossRefGoogle Scholar
  23. 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 31:15–24CrossRefGoogle Scholar
  24. 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 40:555–558PubMedCrossRefGoogle Scholar
  25. 25.
    Fries JF, Spitz P, Kraines RG, Holman HR (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145PubMedCrossRefGoogle Scholar
  26. 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>Google Scholar
  27. 27.
    American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines (2002) Guidelines for the management of rheumatoid arthritis: 2002 update Arthritis Rheum 46:328–346CrossRefGoogle Scholar
  28. 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 29:2077–2083PubMedGoogle Scholar
  29. 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 334:1287–1291PubMedCrossRefGoogle Scholar
  30. 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):72–74Google Scholar
  31. 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):S132Google Scholar
  32. 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 46:1164–1170PubMedCrossRefGoogle Scholar
  33. 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: 326–335PubMedCrossRefGoogle Scholar
  34. 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 51:964–973PubMedCrossRefGoogle Scholar
  35. 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 43:62–72PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Manathip Osiri
    • 1
  • Pirom Kamolratanakul
    • 2
  • Andreas Maetzel
    • 3
  • Peter Tugwell
    • 4
  1. 1.Division of Rheumatology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  2. 2.Department of Preventive and Social Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
  3. 3.Division of Clinical Decision Making, Department of Health Policy, Management and EvaluationUniversity Health Network, University of TorontoTorontoCanada
  4. 4.Centre for Global Health, Institute of Population HealthUniversity of OttawaOttawaCanada

Personalised recommendations