Abstract
BackgroundWhere health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA).MethodsWe used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up.ResultsTwo year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years.ConclusionsWe can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.
Highlights
Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and costutility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA)
One of the Dutch Rheumatoid Arthritis Monitoring (DREAM) cohorts is the DREAM remission induction cohort. With this cohort we have demonstrated that a T2T strategy aiming for remission (Disease Activity Score in 28 joints (DAS28) < 2.6 [8]) is very effective in daily clinical practice, with percentages of DAS28 remission ranging from 47% after six months to 58% after twelve months [9]
The T2T cohort consisted of patients from the DREAM remission induction cohort and the usual care (UC) cohort consisted of patients from the Nijmegen early RA inception cohort [14]
Summary
Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and costutility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA). Taking into account that treating RA comes with potential high costs, it is mandatory to study the balance between costs and effects and gained quality of life. Health economic studies addressing this question frequently use modelling as methodology to evaluate this balance. These studies use data from pivotal trials and best guesses by opinion leaders to feed the model. Real-life data are needed to study the economic impact of innovations in health care compared with usual care
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