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Rheumatoid Arthritis Therapy Options Costs Analyzed

Early treatment with DMARDs found to preserve function well and most cost-effectively

FRIDAY, Nov. 6 (HealthDay News) -- Treatment of early rheumatoid arthritis with disease-modifying antirheumatic drugs (DMARDs) is more cost-effective than the pyramid therapy, but, for now, biologics should be reserved for disease of longer duration or that is unresponsive to other treatment, according to a study in the Nov. 3 Annals of Internal Medicine.

Axel Finckh, M.D., of the University of Geneva in Switzerland, and colleagues analyzed data from the National Data Bank for Rheumatic Diseases and actual 2007 hospital costs. The researchers calculated the cost per quality-adjusted life-year (QALY) for each of three management strategies: 1) the pyramid strategy beginning with initial nonsteroidal anti-inflammatory drugs, patient education, pain management, and low-dose glucocorticoids, and adding DMARDs at one year for patients who do not respond, 2) early DMARD therapy with methotrexate, and 3) early treatment with biologics (tumor necrosis factor inhibitors) and methotrexate.

The researchers found that the early DMARD and biologic strategies both reduced joint damage and increased quality-adjusted life better than the pyramid strategy. For early DMARDs, when the cost of very early intervention was factored in, the cost-effectiveness ratio was $4,849 per QALY compared to the pyramid strategy. However, the benefits gained with early treatment with biologics cost $727,894 per QALY. The authors note that the early biologic strategy could become more cost-effective if the drugs come down in price.

"According to the most objective measures of rheumatoid arthritis progression, very early intervention with conventional DMARDs is cost-effective. The cost-effectiveness of very early intervention with biologics remains uncertain," Finckh and colleagues conclude.

Several study authors reported receiving honoraria or having consulting arrangements or pending grant applications with several pharmaceutical companies.

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