The cost-effectiveness of liver biopsy in rheumatoid arthritis patients treated with methotrexate.
OBJECTIVE
To assess the cost-effectiveness of liver biopsy in monitoring rheumatoid arthritis (RA) patients for methotrexate (MTX)-induced cirrhosis.


METHODS
A decision analytic model was used to compare a strategy of no biopsy versus strategies of biopsy after 5 years or 10 years of MTX treatment.


RESULTS
Biopsy after 5 years of MTX treatment had a cost-effectiveness ratio of $1,891,830 per year of life saved, while biopsy after 10 years of treatment had a cost-effectiveness ratio of $52,374 per year of life saved. Sensitivity analyses revealed that the cost-effectiveness of biopsy was most dependent on the probability of cirrhosis.


CONCLUSIONS
Liver biopsy to monitor for MTX-induced cirrhosis in RA patients is not cost effective after 5 years of treatment, and even biopsy after 10 years has a high cost.
Bergquist
S R
SR
Boston University School of Medicine, Massachusetts.
Felson
D T
DT
Prashker
M J
MJ
Freedberg
K A
KA
D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D001706:Biopsy / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000473:pathology* / Q000517:prevention & control; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D011788:Quality of Life; D012680:Sensitivity and Specificity; D026712:Value of Life
D008727:Methotrexate