TY - JOUR T1 - Cost-effectiveness of Biological Disease-modifying Antirheumatic Drugs for the Treatment of Rheumatoid Arthritis: Implications for Clinical Practice JF - The Journal of Rheumatology JO - J Rheumatol SP - 965 LP - 967 DO - 10.3899/jrheum.170334 VL - 44 IS - 7 AU - T. MARTIJN KUIJPER AU - LEANDER R. BUISMAN AU - JOHANNA M. HAZES AU - ANGELIQUE E. WEEL Y1 - 2017/07/01 UR - http://www.jrheum.org/content/44/7/965.abstract N2 - In this issue of The Journal, Stevenson, et al present an economic model on the cost-effectiveness of biological disease-modifying antirheumatic drugs (bDMARD) for rheumatoid arthritis (RA) in patients who can tolerate methotrexate (MTX)1. Their work formed part of the evidence used by the UK National Institute for Health and Care Excellence (NICE) to update the technology appraisal guidance on the application of bDMARD in RA. In England, because prescription of bDMARD is restricted to patients with RA who have failed at least 2 conventional DMARD and have high disease activity [28-joint Disease Activity Score (DAS28) > 5.1], there was specific interest in the question of whether prescriptions should also be extended to those with moderate disease. The model presented is based on the healthcare setting in England and compares the continuous administration of nonbiological therapy to treatment with sequences of bDMARD in patients with moderate and moderate-to-severe RA. The authors report that the cost per quality-adjusted life-year (QALY) gained by bDMARD strategies over nonbiological DMARD treatment only was £41,600 (US $51,628) for patients with severe RA and £51,100 for patients with moderate to severe RA, a cost well beyond the generally accepted NICE threshold of £20,000–£30,000. In subanalyses, restricting biologicals to patients with the worst prognosis with non-biological therapy only, more favorable cost-effectiveness ratios were found: £25,300 per QALY for severe and £28,500 per QALY for moderate to severe RA. Hence the authors conclude that the cost-effectiveness of the administration of bDMARD in RA in England is questionable and meets currently accepted levels only in subsets of patients with the worst … Address correspondence to Dr. T.M. Kuijper, Maasstad Hospital, Department of Rheumatology, Postbus 9100, 3007 AC Rotterdam, The Netherlands; E-mail: kuijpert{at}maasstadziekenhuis.nl ER -