In Rheumatoid Arthritis, Adding a Biologic Agent Before Trying Triple Therapy Likely Not Cost-Effective — Physician’s First Watch
In Rheumatoid Arthritis, Adding a Biologic Agent Before Trying Triple Therapy Likely Not Cost-Effective
By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH
For patients with active rheumatoid arthritis despite methotrexate therapy, adding a biologic agent (e.g., etanercept) before trying triple therapy would lead to substantial cost increases without much clinical benefit, an Annals of Internal Medicine study finds.
Researchers conducted a cost-effectiveness analysis using data from a trial in which 350 people with active rheumatoid arthritis despite methotrexate treatment were randomized to receive either triple therapy (methotrexate, sulfasalazine, and hydroxychloroquine) or methotrexate plus etanercept. In the initial trial, triple therapy seemed noninferior to methotrexate-etanercept in terms of disease activity.
Now, the cost-effectiveness analysis shows that methotrexate-etanercept may lead to slightly better outcomes than triple therapy, but at a high price: namely, an additional 0.15 quality-adjusted life-years (55 days of perfect health in a lifetime) would cost an extra $77,000.
The authors conclude that going right to a biologic agent after methotrexate failure "is unlikely to be cost-effective ... even under optimistic assumptions."