Rheumatology International

, Volume 36, Issue 2, pp 231–241 | Cite as

Real-world cost-effectiveness of infliximab, etanercept and adalimumab in rheumatoid arthritis patients: results of the CREATE registry

  • M. Cárdenas
  • S. de la Fuente
  • P. Font
  • M. C. Castro-Villegas
  • M. Romero-Gómez
  • D. Ruiz-Vílchez
  • J. Calvo-Gutiérez
  • A. Escudero-Contreras
  • M. A. Casado
  • J. R. Del Prado
  • E. Collantes-Estévez
Original Article - Health Services Research


Biological drugs have proven efficacy and effectiveness in treatment of rheumatoid arthritis (RA), although none has been shown to be superior. Few studies have evaluated the cost-effectiveness of biological drugs in real-life clinical conditions. The objective of this study was to compare the cost-effectiveness of infliximab, etanercept and adalimumab in achieving clinical remission (DAS28 < 2.6) when used as initial biological therapy. Patients were diagnosed with RA who began treatment with infliximab, etanercept or adalimumab in the Reina Sofia Hospital (Cordoba, Spain) between January 1, 2007, and December 31, 2012. Effectiveness was measured as the percentage of patients who achieved clinical remission after 2 years. The cost analysis considered the use of direct health resources (perspective of the healthcare system). Cost-effectiveness was calculated by dividing the total mean cost of each treatment by the percentage of patients who achieved remission. One hundred and thirty patients were included: 55 with infliximab, 44 with adalimumab and 31 with etanercept. After 2 years, 45.2 % of patients with adalimumab achieved clinical remission, versus 29.1 % with infliximab (p = 0.133) and 22.7 % with etanercept (p = 0.040), with no differences between etanercept and infliximab (p = 0.475). The average total cost at 2 years was €29,858, €25,329 and €23,309 for adalimumab, infliximab and etanercept, respectively, while the mean cost (95 %CI) to achieve remission was €66,057 (48,038–84,076), €87,040 (78,496–95,584) and €102,683 (94,559–110,807), respectively. Adalimumab was more efficient than etanercept (p < 0.001) and infliximab (p = 0.026), with no differences between etanercept and infliximab (p = 0.086). Adalimumab was the most cost-effective treatment in achieving clinical remission in real-life clinical conditions in RA patients during the study period.


Rheumatoid arthritis Biological drugs Cost-effectiveness Real-life clinical conditions 



The authors would like to thank Mª Dolores Aguilar-Conesa for technical assistance. No funding has been received to carry out this study or for preparation of the manuscript.

Compliance with ethical standards

The study meets the standards of Good Clinical Practice, the principles of the Declaration of Helsinki and Order SAS 347/2009 of December 16, which develops guidelines on observational post-authorization studies for drugs used in humans in Spain. Patient data are coded to maintain anonymity in the study and to prevent their identification by third parties. The study was approved by the Ethical Committee of the Reina Sofia University Hospital of Cordoba.

Conflict of interest

Cárdenas M, Font P, Castro-Villegas and Collantes-Estévez E report grants, consulting fees, or lecture fees from MSD, Pfizer or AbbVie, none of which were related to the present work. De la Fuente S, Romero-Alonso M, Calvo-Gutiérrez J, Escudero-Contreras A, Casado MA and Del Prado JR have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • M. Cárdenas
    • 1
    • 2
  • S. de la Fuente
    • 1
  • P. Font
    • 2
    • 3
    • 4
  • M. C. Castro-Villegas
    • 2
    • 3
    • 4
  • M. Romero-Gómez
    • 2
    • 3
    • 4
  • D. Ruiz-Vílchez
    • 2
    • 3
    • 4
  • J. Calvo-Gutiérez
    • 2
    • 3
    • 4
  • A. Escudero-Contreras
    • 2
    • 3
    • 4
  • M. A. Casado
    • 5
  • J. R. Del Prado
    • 1
  • E. Collantes-Estévez
    • 2
    • 3
    • 4
  1. 1.Pharmacy DepartmentReina Sofía Universitary HospitalCórdobaSpain
  2. 2.University of CórdobaCórdobaSpain
  3. 3.Rheumatology DepartmentReina Sofía Universitary HospitalCórdobaSpain
  4. 4.IMIBICCórdobaSpain
  5. 5.Pharmacoeconomics & Outcomes Research Iberica (PORIB)MadridSpain

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