Economic evaluation of folate supplementation during methotrexate treatment in rheumatoid arthritis.
OBJECTIVE
To determine cost-effectiveness of folic or folinic acid supplementation in patients with rheumatoid arthritis (RA) who started methotrexate (MTX) treatment.


METHODS
An economic evaluation, performed alongside a randomized, double blind, placebo controlled trial with followup of 48 weeks. Patients started MTX with placebo (n = 137), folic acid (n = 133), or folinic acid (n = 141). Outcome measures were drug survival and quality-adjusted life-years (QALY), measured with the EuroQol questionnaire. Both medical and nonmedical costs were analyzed.


RESULTS
Drug survival after 48 weeks was 60% for placebo, 81% for folic acid, and 87% for folinic acid. QALY during a 48 week period were 0.55 (95% CI 0.52-0.58) in the placebo group, 0.55 (95% CI 0.52-0.58) in the folic acid group, and 0.58 (95% CI 0.56-0.60) in the folinic acid group. Mean medical costs were 1398 US dollars (placebo), 1409 US dollars (folic acid), and 1776 US dollars (folinic acid). Mean total costs were 3339 US dollars, 3632 US dollars, and 3296 US dollars, respectively.


CONCLUSIONS
In terms of resource deployment, no statistically significant difference was found between the 3 strategies. The preferred strategy consists of folic acid supplementation because of improved drug survival.
Hartman
Margriet
M
Department of Medical Technology Assessment, University Medical Centre, Nijmegen, The Netherlands. M.Moret@mta.umcn.nl
van Ede
Annelies
A
Severens
Johan L
JL
Laan
Roland F J M
RF
van de Putte
Leo
L
van der Wilt
Gert Jan
GJ
D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D017048:Health Care Costs; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D010352:Patient Dropouts; D012219:Rheumatology / Q000191:economics / Q000379:methods; D013997:Time Factors
D018501:Antirheumatic Agents; D006397:Hematinics; D005492:Folic Acid; D002955:Leucovorin; D008727:Methotrexate