Cost-effectiveness of abatacept, rituximab, and TNFi treatment after previous failure with TNFi treatment in rheumatoid arthritis: a pragmatic multi-centre randomised trialReport as inadecuate

Cost-effectiveness of abatacept, rituximab, and TNFi treatment after previous failure with TNFi treatment in rheumatoid arthritis: a pragmatic multi-centre randomised trial - Download this document for free, or read online. Document in PDF available to download.

Arthritis Research and Therapy

, 17:134

First Online: 22 May 2015Received: 03 November 2014Accepted: 17 April 2015


IntroductionFor patients with rheumatoid arthritis RA whose treatment with a tumour necrosis factor inhibitor TNFi is failing, several biological treatment options are available. Often, another TNFi or a biological with another mode of action is prescribed. The objective of this study was to compare the effectiveness and cost-effectiveness of three biologic treatments with different modes of action in patients with RA whose TNFi therapy is failing.

MethodsWe conducted a pragmatic, 1-year randomised trial in a multicentre setting. Patients with active RA despite previous TNFi treatment were randomised to receive abatacept, rituximab or a different TNFi. The primary outcome Disease Activity Score in 28 joints and the secondary outcomes Health Assessment Questionnaire Disability Index and 36-item Short Form Health Survey scores were analysed using linear mixed models. Cost-effectiveness was analysed on the basis of incremental net monetary benefit, which was based on quality-adjusted life-years calculated using EQ-5D scores, and all medication expenditures consumed in 1 year. All analyses were also corrected for possible confounders.

ResultsOf 144 randomised patients, 5 were excluded and 139 started taking abatacept 43 patients, rituximab 46 patients or a different TNFi 50 patients. There were no significant differences between the three groups with respect to multiple measures of RA outcomes. However, our analysis revealed that rituximab therapy is significantly more cost-effective than both abatacept and TNFi over a willingness-to-pay range of 0 to 80,000 euros.

ConclusionsAll three treatment options were similarly effective; however, when costs were factored into the treatment decision, rituximab was the best option available to patients whose first TNFi treatment failed. However, generalization of these costs to other countries should be undertaken carefully.

Trial registrationNetherlands Trial Register number NTR1605. Registered 24 December 2008.


CIConfidence interval

csDMARDConventional synthetic disease-modifying antirheumatic drug

DAS28Disease Activity Score in 28 joints

ESRErythrocyte sedimentation rate

EULAREuropean League Against Rheumatism

HAQ-DIHealth Assessment Questionnaire Disability Index

INMBIncremental net monetary benefit

IQRInterquartile range

QALYQuality-adjusted life-year

RARheumatoid arthritis

RFRheumatoid factor


SDStandard deviation

SF-3636-item Short Form Health Survey

SUSARSuspected unexpected serious adverse reaction

TNFiTumour necrosis factor inhibitor


WTPWillingness to pay

Electronic supplementary materialThe online version of this article doi:10.1186-s13075-015-0630-5 contains supplementary material, which is available to authorized users.

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Author: Sofie HM Manders - Wietske Kievit - Eddy Adang - Herman L Brus - Hein J Bernelot Moens - Andre Hartkamp - Lidy Hendriks


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