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Arthritis Care Res (Hoboken). 2019 Jan 10. doi: 10.1002/acr.23830. [Epub ahead of print]

Cost-effectiveness of combination disease-modifying antirheumatics vs. tumour necrosis factor inhibitors in active rheumatoid arthritis: TACIT trial.

Author information

1
Anita Patel Health Economics Consulting Ltd, 160 City Road, London, EC1V 2NX.
2
King's College London, Health Service & Population Research, London.
3
King's College London, Rheumatology, London.
4
King's College London, Biostatistics, London.
5
Northumbria Healthcare NHS Foundation Trust, Rheumatology, North Shields.

Abstract

OBJECTIVE:

To determine whether intensive combinations of synthetic disease modifying drugs (cDMARDS) achieve similar clinical benefits more cheaply than high-cost biologics such as tumour necrosis factor inhibitors (TNFis) in patients with active rheumatoid arthritis (RA) who have failed to respond to methotrexate and another DMARD.

METHODS:

Within-trial, cost-effectiveness and cost-utility analyses from health and social care (H&SC) and two societal perspectives. Participants were recruited into an open-label, 12-month, pragmatic, randomised, multicentre, two-arm, non-inferiority trial in 24 rheumatology clinics in England. Costs were linked with the Heath Assessment Questionnaire (HAQ; primary outcome) and quality-adjusted life years (QALYs) derived from two measures (SF-36, EQ-5D-3L).

RESULTS:

205 participants were recruited, 104 in the cDMARDs arm, 101 in the TNFis arm. cDMARD arm participants with poor response at 6 months were offered TNFis; 46 (44%) switched. Relevant cost and outcome data were available for 93% of participants at 6 month follow-up and 91-92% at 12 month follow-up. The cDMARDs arm had significantly lower total costs from all perspectives (6 month H&SC adjusted mean difference -£3615 (95% confidence interval -£4104 to -£3182); 12 month H&SC adjusted mean difference -£1930 (95% confidence interval -£2599 to -£1301)). The HAQ showed benefit to the cDMARDs arm at 12 months (-0.16; 95% CI-0.32 to -0.01); other outcomes/follow-ups showed no differences.

CONCLUSION:

Starting treatment with cDMARDs, rather than TNFis, achieves similar outcomes at significantly lower costs. Patients with active rheumatoid arthritis and meeting NICE criteria for expensive biologics can cost-effectively be treated with combinations of intensive synthetic disease modifying drugs. This article is protected by copyright. All rights reserved.

KEYWORDS:

Anti-TNF; DMARDs; Economic evaluations; Rheumatoid Arthritis

PMID:
30629813
DOI:
10.1002/acr.23830

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