Abstract

Background. Early onset biological treatment is favoured in early active rheumatoid arthritis (RA) treatment guidelines.

Aim. To assess the cost-effectiveness and the budget impact of the earlier use of biologic disease-modifying antirheumatic drugs (DMARDs) in treatment of RA. This review is based on the assessment of health technology carried out at the Institute of Family Medicine and Public Health, University of Tartu.

Methods. To describe standard RA treatment, the records of East Tallinn Central Hospital were analysed. The Markov microsimulation model was used to compare the treatment strategies for lifetime health effects, treatment costs, and indirect costs. The impact of early onset therapy on the public health insurance budget was estimated.

Results. Today, 3.4 (SD=0.9) synthetic DMARDS are used prior to initiating biological treatment. Compared to the use of standard biologic treatment, early onset treatment results in a small health gain of 0.1-0.2 QALY per patient, at a cost of €67,000 per QALY. The annual incremental cost of early onset treatment is 0.4-0.8 mln euro.

Conclusions. Health gain from the early onset biological therapy is relatively small and comes at an escalated economic cost, however, the budget impact is modest. The reallocation decision to support early biological treatment is driven by the treatment recommendations and public insurance capability.