Featured Research

from universities, journals, and other organizations

Combination DMARDs more cost-effective with comparable lifetime results than anti-TNF therapy in treating rheumatoid arthritis

Date:
October 27, 2013
Source:
American College of Rheumatology (ACR)
Summary:
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, according to new research.

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, according to new research findings 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.


Story Source:

The above story is based on materials provided by American College of Rheumatology (ACR). Note: Materials may be edited for content and length.


Cite This Page:

American College of Rheumatology (ACR). "Combination DMARDs more cost-effective with comparable lifetime results than anti-TNF therapy in treating rheumatoid arthritis." ScienceDaily. ScienceDaily, 27 October 2013. <www.sciencedaily.com/releases/2013/10/131027123041.htm>.
American College of Rheumatology (ACR). (2013, October 27). Combination DMARDs more cost-effective with comparable lifetime results than anti-TNF therapy in treating rheumatoid arthritis. ScienceDaily. Retrieved September 20, 2014 from www.sciencedaily.com/releases/2013/10/131027123041.htm
American College of Rheumatology (ACR). "Combination DMARDs more cost-effective with comparable lifetime results than anti-TNF therapy in treating rheumatoid arthritis." ScienceDaily. www.sciencedaily.com/releases/2013/10/131027123041.htm (accessed September 20, 2014).

Share This



More Health & Medicine News

Saturday, September 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Could Grief Affect The Immune Systems Of Senior Citizens?

Could Grief Affect The Immune Systems Of Senior Citizens?

Newsy (Sep. 19, 2014) The study found elderly people are much more likely to become susceptible to infection than younger adults going though a similar situation. Video provided by Newsy
Powered by NewsLook.com
Jury Delivers Verdict in Salmonella Trial

Jury Delivers Verdict in Salmonella Trial

AP (Sep. 19, 2014) A federal jury has convicted three people in connection with an outbreak of salmonella poisoning five years ago that sickened hundreds of people and was linked to a number of deaths. (Sept. 19) Video provided by AP
Powered by NewsLook.com
How The 'Angelina Jolie Effect' Increased Cancer Screenings

How The 'Angelina Jolie Effect' Increased Cancer Screenings

Newsy (Sep. 19, 2014) Angelina's Jolie's decision to undergo a preventative mastectomy in 2013 inspired many women to seek early screenings for the disease. Video provided by Newsy
Powered by NewsLook.com
The Cost of Ebola

The Cost of Ebola

Reuters - Business Video Online (Sep. 18, 2014) As Sierra Leone prepares for a three-day "lockdown" in its latest bid to stem the spread of Ebola, Ciara Lee looks at the financial implications of fighting the largest ever outbreak of the disease. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins