Anti-TNF Therapy Isn't as Cost Effective As Combination DMARDs in Treating Rheumatoid Arthritis

by Rukmani Krishna on October 30, 2013 at 12:00 AM
 Anti-TNF Therapy Isn't as Cost Effective As Combination DMARDs in Treating Rheumatoid Arthritis

New research reveals that starting with a combination of three traditional disease-modifying antirheumatic drugs (called DMARDs) for treating early rheumatoid arthritis is more cost-effective long term, with comparable benefits, than using either an immediate or step-up approach with anti-tumor necrosis factor (called Anti-TNFs) drugs and methotrexate. The findings of the research was presented this week at the American College of Rheumatology Annual Meeting in San Diego.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.


Researchers at the University of Nebraska Medical Center, the University of Minnesota, the University of Alabama at Birmingham, the University of Pittsburgh, and the National Data Bank for Rheumatic Diseases compared the long-term cost-effectiveness of using a triple therapy approach to treating early RA with using a more aggressive approach with a newer, TNF-inhibitor agent plus methotrexate.

The researchers used patient data from the double-blind, randomized, two-year Treatment of Early Aggressive RA (TEAR) trial and the National Data Bank for Rheumatic Diseases to measure treatment outcomes and estimate long-term cost of these therapies. They evaluated four strategies: Immediate triple therapy of methotrexate, sulfasalazine and hydroxychloroquine; immediate therapy of etancercept, an anti-TNF agent, and methotrexate; a step-up triple therapy and a step-up etanercept therapy. The two step-up therapies involve switching a patient with persistent disease activity from methotrexate monotherapy to either triple therapy or methotrexate plus etanercept after six months. The researchers simulated an extension of the two years of TEAR results to lifetime use of the therapies to estimate the long-term cost.

"Randomized controlled trials between active therapies are rare and important in treating RA. We felt it was important to determine the quantitative differences between these four treatment arms of early RA," says Kaleb Michaud, PhD; assistant professor, University of Nebraska Medical Center & co-director, National Data Bank for Rheumatic Diseases; and lead investigator in the study.

The researchers estimated Quality Adjusted Life Year (called QALY) measurements by analyzing various data from TEAR, including disease-activity scores in 28 joints and results of Health Assessment Questionnaires. They used a Markov simulation model to estimate QALY measurements and the costs associated with therapy approaches in the TEAR trial. QALY is a standard measurement to determine the effectiveness of various medical interventions in achieving quality and quantity of life over the long term.

Looking at the four therapy approaches, the researchers determined that the lifetime benefits of all four were comparable, or within 0.06 QALY scores. However, the two therapies using etanercept were almost twice as expensive due to the higher cost of the anti-TNF agent. The researchers estimated that the incremental cost-effectiveness ratio of using immediate etanercept therapy versus immediate triple therapy was $837,100 per QALY score over the long term. This increase in cost and the difference in incremental cost-effectiveness ratio may be too high for many health care settings to find acceptable, considering the comparable benefits, the researchers concluded.

"The current ACR treatment guidelines for early RA indicate initiating after methotrexate either a concomitant anti-TNF biologic or another non-biologic DMARD depending on the severity of the prognosis," Dr. Michaud says. "While this study should not change those guidelines, our results suggest that physicians should consider use of triple therapy as a viable alternative to a biologic for patients where costs may be an impediment to care."

Patients should talk to their rheumatologists to determine their best course of treatment.

Source: Newswise
Font : A-A+



Recommended Readings

Latest General Health News

First Human Case of Rare Swine Flu Strain H1N2 Found in UK
Swine influenza A viruses, including subtypes H1N1, H1N2, and H3N2, are prominent among pigs and sporadically transmit to humans.
Unraveling the Mystery Respiratory Illness in US Dogs
The microorganism "is a newly identified potential disease-causing agent, possibly originating from or evolving within the dog's microbiome."
Why Red Wine Cause Headache?
Flavanol naturally present in red wine can compromise the proper metabolism of alcohol and lead to a headache.
Raw Meat Raises Antibiotic-Resistant E.Coli Risk in Dogs
To reduce bacterial risks, pet owners can switch to a non-raw diet or obtain quality raw meat for cooking before feeding dogs.
U.S. Men Die 6 Years Earlier Than Women- A Review on Life Expectancy Gap
Since 2010, the gender gap in life expectancy in the US has increased to six years because of the pandemic, accidents, opioid overdoses, injuries, and suicide.
View All
This site uses cookies to deliver our services.By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use  Ok, Got it. Close

Anti-TNF Therapy Isn't as Cost Effective As Combination DMARDs in Treating Rheumatoid Arthritis Personalised Printable Document (PDF)

Please complete this form and we'll send you a personalised information that is requested

You may use this for your own reference or forward it to your friends.

Please use the information prudently. If you are not a medical doctor please remember to consult your healthcare provider as this information is not a substitute for professional advice.

Name *

Email Address *

Country *

Areas of Interests