Cost-effectiveness of treatment strategies using combination disease-modifying anti-rheumatic drugs and glucocorticoids in early rheumatoid arthritis.
OBJECTIVE
The aim of this study was to estimate the cost-effectiveness of combination DMARDs with short-term glucocorticoids in early active RA using data from the 2-year Combination of Anti-Rheumatic Drugs in Early RA (CARDERA) trial.


METHODS
CARDERA enrolled 467 patients with active RA of <24-months duration. All patients received MTX; half received step-down prednisolone and half ciclosporin in a placebo-controlled factorial design. Differences in mean costs and quality-adjusted life-years (QALYs) over 24-months follow-up were estimated using patient-level data from a UK health service perspective and 2011-12 costs.


RESULTS
Two-year costs for each treatment strategy showed primary care costs were negligible across all groups. Drug costs were lowest with MTX/ciclosporin and triple therapy. Hospital costs were lowest with MTX/prednisolone and triple therapy. Triple therapy was least costly and most effective; it dominated all other strategies. At positive values for a QALY in the typical UK range (£20 000-30 000) the probability that triple therapy was the most cost-effective strategy was 0.9. Results were robust to methods used to impute missing data.


CONCLUSIONS
Intensive treatment of early RA with triple therapy (two DMARDs and short-term glucocorticoids) is both clinically effective and cost effective.
School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK. a.j.wailoo@sheffield.ac.uk.
Allan
A
Wailoo
School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK.
Mónica
M
Hernández Alava
School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK.
Ian C
IC
Scott
School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK.
Fowzia
F
Ibrahim
School of Health and Related Research, University of Sheffield, Sheffield, Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation and Department of Rheumatology, King's College Hospital, London, UK.
David L
DL
Scott
D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000191:economics* / Q000627:therapeutic use; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D005938:Glucocorticoids / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D016572:Cyclosporine; D011239:Prednisolone
anti-rheumatic agents; economics; glucocorticoids; rheumatoid arthritis