title: Cost-effectiveness of biologic compared with conventional synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis: a Register study.
abstract: OBJECTIVE
  The aim of this study was to explore the cost-effectiveness of biological DMARDs (bDMARDs) compared with conventional synthetic DMARDs (csDMARDs) for RA using real-world data from Finnish registers.
  
  
  METHODS
  RA patients starting their first bDMARD and comparator patients using csDMARDs during 2007-11 were obtained from the National register of biologic treatments in Finland and the Jyväskylä Central Hospital patient records. Propensity score matching was applied to adjust for differences between bDMARD and csDMARD users. Effectiveness was measured in quality-adjusted life years (QALY) and based on the register of biologic treatments in Finland and Jyväskylä Central Hospital patient records, whereas the direct costs were obtained from relevant Finnish national registers. Patients were followed up for 2 years, and both costs and effectiveness for the second year were discounted at 3%. The incremental cost-effectiveness ratio (ICER) with 95% CI was calculated based on bootstrapped mean costs and effectiveness.
  
  
  RESULTS
  Of 1581 RA patients meeting study inclusion criteria, 552 bDMARD and 220 csDMARD users were included in analyses after matching. Mean costs for bDMARDs and csDMARDs were €55 371 and €24 879, while mean effectiveness was 1.23 and 1.20 QALYs, respectively. Consequent ICER was €902 210/QALY. Results were confirmed in sensitivity analyses.
  
  
  CONCLUSIONS
  The high incremental cost and the small, non-significant difference in effectiveness resulted in high ICER, suggesting that bDMARDs are not cost-effective. Regardless of matching, latent confounders may introduce bias to the results.
authors.affiliation: Faculty of Pharmacy, University of Helsinki, Helsinki jaana.joensuu@helsinki.fi.
authors.forename: Jaana T
authors.initials: JT
authors.lastname: Joensuu
authors.affiliation: Faculty of Pharmacy, University of Helsinki, Helsinki.
authors.forename: Kalle J
authors.initials: KJ
authors.lastname: Aaltonen
authors.affiliation: Faculty of Pharmacy, University of Helsinki, Helsinki.
authors.forename: Pasi
authors.initials: P
authors.lastname: Aronen
authors.affiliation: Department of Rheumatology, Jyväskylä Central Hospital, Jyväskylä
authors.forename: Tuulikki
authors.initials: T
authors.lastname: Sokka
authors.affiliation: Department of Medicine, South Karelia Central Hospital, Lappeenranta.
authors.forename: Kari
authors.initials: K
authors.lastname: Puolakka
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Helsinki.
authors.forename: Riitta
authors.initials: R
authors.lastname: Tuompo
authors.affiliation: Centre for Rheumatic Diseases, Tampere University Hospital, Tampere.
authors.forename: Markku
authors.initials: M
authors.lastname: Korpela
authors.affiliation: Department of Internal Medicine, Kainuu Central Hospital, Kajaani.
authors.forename: Mikko
authors.initials: M
authors.lastname: Vasala
authors.affiliation: Department of Medicine, Kanta-Häme Central Hospital, Hämeenlinna.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Ilva
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Helsinki Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Dan
authors.initials: D
authors.lastname: Nordström
authors.affiliation: Faculty of Pharmacy, University of Helsinki, Helsinki.
authors.forename: Marja
authors.initials: M
authors.lastname: Blom
mesh_terms: D000068879:Adalimumab / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D000068800:Etanercept / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005387:Finland; D006760:Hospitalization / Q000191:economics; D006801:Humans; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D000069283:Rituximab / Q000191:economics / Q000627:therapeutic use
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D000069283:Rituximab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: biological DMARDs; cost-effectiveness; observational study; rheumatoid arthritis