Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial

Pascal H P de Jong; Johanna M Hazes; Leander R Buisman; Pieternella J Barendregt; Derkjen van Zeben; Peter A van der Lubbe; Andreas H Gerards; Mike H de Jager; Peter B J de Sonnaville; Bernard A Grillet; Jolanda J Luime; Angelique E A M Weel

doi:10.1093/rheumatology/kew321

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial

Pascal H P de Jong^*, Johanna M Hazes, Leander R Buisman, Pieternella J Barendregt, Derkjen van Zeben, Peter A van der Lubbe, Andreas H Gerards, Mike H de Jager, Peter B J de Sonnaville, Bernard A Grillet, Jolanda J Luime, Angelique E A M Weel

^*Corresponding author for this work

Rheumatology

Research output: Contribution to journal › Article › Academic › peer-review

13 Citations (Web of Science)

Abstract

OBJECTIVE: To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA.

METHODS: The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity.

RESULTS: Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM.

CONCLUSION: iTDT was more cost-effective and had better worker productivity compared with iMM.

Original language	English
Pages (from-to)	2138-2147
Number of pages	10
Journal	Rheumatology
Volume	55
Issue number	12
DOIs	https://doi.org/10.1093/rheumatology/kew321
Publication status	Published - Dec 2016

Bibliographical note

Funding:
This work was supported by an unrestricted
grant from Pfizer bv. [0881-102217]. Pfizer had no involvement in study design; in collection, analysis and interpretation of data; writing of the report and decision to submit
for publication.

© The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].

Research programs

EMC NIHES-05-63-02 Quality
EMC MUSC-01-31-01

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/rheumatology/kew321

Cite this

de Jong, P. H. P., Hazes, J. M., Buisman, L. R., Barendregt, P. J., van Zeben, D., van der Lubbe, P. A., Gerards, A. H., de Jager, M. H., de Sonnaville, P. B. J., Grillet, B. A., Luime, J. J., & Weel, A. E. A. M. (2016). Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial. Rheumatology, 55(12), 2138-2147. https://doi.org/10.1093/rheumatology/kew321

@article{bb75c959d3344dc6bb1e45c47ff42a08,

title = "Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial",

abstract = "OBJECTIVE: To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA.METHODS: The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity.RESULTS: Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM.CONCLUSION: iTDT was more cost-effective and had better worker productivity compared with iMM.",

author = "{de Jong}, {Pascal H P} and Hazes, {Johanna M} and Buisman, {Leander R} and Barendregt, {Pieternella J} and {van Zeben}, Derkjen and {van der Lubbe}, {Peter A} and Gerards, {Andreas H} and {de Jager}, {Mike H} and {de Sonnaville}, {Peter B J} and Grillet, {Bernard A} and Luime, {Jolanda J} and Weel, {Angelique E A M}",

note = "Funding: This work was supported by an unrestricted grant from Pfizer bv. [0881-102217]. Pfizer had no involvement in study design; in collection, analysis and interpretation of data; writing of the report and decision to submit for publication. {\textcopyright} The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].",

year = "2016",

month = dec,

doi = "10.1093/rheumatology/kew321",

language = "English",

volume = "55",

pages = "2138--2147",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "12",

}

de Jong, PHP , Hazes, JM, Buisman, LR, Barendregt, PJ, van Zeben, D, van der Lubbe, PA, Gerards, AH, de Jager, MH, de Sonnaville, PBJ, Grillet, BA, Luime, JJ & Weel, AEAM 2016, 'Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial', Rheumatology, vol. 55, no. 12, pp. 2138-2147. https://doi.org/10.1093/rheumatology/kew321

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial. / de Jong, Pascal H P ; Hazes, Johanna M; Buisman, Leander R et al.
In: Rheumatology, Vol. 55, No. 12, 12.2016, p. 2138-2147.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis

T2 - cost-utility analysis of the tREACH trial

AU - de Jong, Pascal H P

AU - Hazes, Johanna M

AU - Buisman, Leander R

AU - Barendregt, Pieternella J

AU - van Zeben, Derkjen

AU - van der Lubbe, Peter A

AU - Gerards, Andreas H

AU - de Jager, Mike H

AU - de Sonnaville, Peter B J

AU - Grillet, Bernard A

AU - Luime, Jolanda J

AU - Weel, Angelique E A M

N1 - Funding: This work was supported by an unrestricted grant from Pfizer bv. [0881-102217]. Pfizer had no involvement in study design; in collection, analysis and interpretation of data; writing of the report and decision to submit for publication. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].

PY - 2016/12

Y1 - 2016/12

N2 - OBJECTIVE: To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA.METHODS: The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity.RESULTS: Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM.CONCLUSION: iTDT was more cost-effective and had better worker productivity compared with iMM.

AB - OBJECTIVE: To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA.METHODS: The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity.RESULTS: Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM.CONCLUSION: iTDT was more cost-effective and had better worker productivity compared with iMM.

UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=eur_pure&SrcAuth=WosAPI&KeyUT=WOS:000393316300007&DestLinkType=FullRecord&DestApp=WOS

U2 - 10.1093/rheumatology/kew321

DO - 10.1093/rheumatology/kew321

M3 - Article

C2 - 27581208

SN - 1462-0324

VL - 55

SP - 2138

EP - 2147

JO - Rheumatology

JF - Rheumatology

IS - 12

ER -

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial

Abstract

Bibliographical note

Research programs

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this