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Ann Rheum Dis. 2004 Jan; 63(1): 4–10.
PMCID: PMC1754715

TNF inhibitors in the treatment of rheumatoid arthritis in clinical practice: costs and outcomes in a follow up study of patients with RA treated with etanercept or infliximab in southern Sweden


Materials and methods: At four rheumatology units in southern Sweden treatment of 160 consecutive patients with RA was started with either etanercept or infliximab. The economic analysis was based on 116 patients with complete data who received treatment for at least one year. Details on drug treatment, functional capacity, disease activity, and laboratory values were available during the entire treatment. Information on resource use and QoL was collected at baseline and throughout the first year. The cost effectiveness analysis was based on changes in outcome and costs compared with the year before treatment. Cost per quality adjusted life year (QALY) gained was calculated for the entire sample and for patients with different levels of functional disability.

Results: During the first treatment year direct costs were reduced by 40%, but indirect costs did not change substantially. Patients' QoL improved on treatment—utility increased from an average of 0.28 to 0.65. Assuming that improvement occurred after three months' treatment, the cost per QALY gained is estimated as €43 500. If it occurs after six weeks, in parallel with clinical measures, the cost per QALY is €36 900. Sensitivity analysis, including all 160 patients, gave an estimated cost per QALY of €53 600. The cost per QALY increases for patient groups with less severe disease.

Conclusion: For this patient group, cost effectiveness ratios are within the generally accepted threshold of €50 000, but need to be confirmed with larger samples.

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Selected References

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  • Kobelt G, Eberhardt K, Jönsson L, Jönsson B. Economic consequences of the progression of rheumatoid arthritis in Sweden. Arthritis Rheum. 1999 Feb;42(2):347–356. [PubMed]
  • Kobelt Gisela, Jönsson Linus, Lindgren Peter, Young Adam, Eberhardt Kerstin. Modeling the progression of rheumatoid arthritis: a two-country model to estimate costs and consequences of rheumatoid arthritis. Arthritis Rheum. 2002 Sep;46(9):2310–2319. [PubMed]
  • Wong JB, Ramey DR, Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthritis Rheum. 2001 Dec;44(12):2746–2749. [PubMed]
  • Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A. Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol. 1997 May;36(5):551–559. [PubMed]
  • Kobelt G, Jönsson L, Young A, Eberhardt K. The cost-effectiveness of infliximab (Remicade) in the treatment of rheumatoid arthritis in Sweden and the United Kingdom based on the ATTRACT study. Rheumatology (Oxford) 2003 Feb;42(2):326–335. [PubMed]
  • Wong John B, Singh Gurkirpal, Kavanaugh Arthur. Estimating the cost-effectiveness of 54 weeks of infliximab for rheumatoid arthritis. Am J Med. 2002 Oct 1;113(5):400–408. [PubMed]
  • Geborek P, Crnkic M, Petersson IF, Saxne T. Etanercept, infliximab, and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden. Ann Rheum Dis. 2002 Sep;61(9):793–798. [PMC free article] [PubMed]
  • Ekdahl C, Eberhardt K, Andersson SI, Svensson B. Assessing disability in patients with rheumatoid arthritis. Use of a Swedish version of the Stanford Health Assessment Questionnaire. Scand J Rheumatol. 1988;17(4):263–271. [PubMed]
  • Brooks R. EuroQol: the current state of play. Health Policy. 1996 Jul;37(1):53–72. [PubMed]
  • Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, van Riel PL, Tugwell P. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford) 2003 Feb;42(2):244–257. [PubMed]
  • Almbrand B, Johannesson M, Sjöstrand B, Malmberg K, Rydén L. Cost-effectiveness of intense insulin treatment after acute myocardial infarction in patients with diabetes mellitus; results from the DIGAMI study. Eur Heart J. 2000 May;21(9):733–739. [PubMed]
  • Johannesson M. At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention? Eur Heart J. 2001 Jun;22(11):919–925. [PubMed]

Figures and Tables

Figure 1
Development of functional disability (HAQ), disease activity (DAS28), and steroid use over time. The box plots represent the 10th, 25th, median, 75th, and 90th centiles.

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