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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.

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



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.


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).


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.


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.


Anti-TNF; DMARDs; Economic evaluations; Rheumatoid Arthritis


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