title: Economic aspects of treatment options in rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis.
abstract: 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 alpha 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.
authors.affiliation: 2nd Department of Internal Medicine, Hietzing Hospital, Wolkersbergenstrasse 1, 1130 Vienna, Austria. monika.schoels@chello.at
authors.forename: Monika
authors.initials: M
authors.lastname: Schoels
authors.forename: John
authors.initials: J
authors.lastname: Wong
authors.forename: David L
authors.initials: DL
authors.lastname: Scott
authors.forename: Angela
authors.initials: A
authors.lastname: Zink
authors.forename: Pamela
authors.initials: P
authors.lastname: Richards
authors.forename: Robert
authors.initials: R
authors.lastname: Landewé
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D017211:Treatment Failure; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha