Economic evaluation of a tight-control treatment strategy using an imaging device (handscan) for monitoring joint inflammation in early rheumatoid arthritis

• Published in: Clinical and experimental rheumatology Vol. 33; no. 6; pp. 831 - 838
• Main Authors: Nair, S C, Welsing, P M J, Jacobs, J W G, van Laar, J M, Rensen, W H J, Ardine de Wit, G, Bijlsma, J W J, Lafeber, F P J G
• Format: Journal Article
• Language: English
• Published: Italy 01.11.2015
• Subjects: Adult; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - economics; Arthritis, Rheumatoid - therapy; Cost-Benefit Analysis; Drug Monitoring - economics; Drug Monitoring - methods; Female; Humans; Male; Markov Chains; Methotrexate - therapeutic use; Middle Aged; Netherlands; Outcome and Process Assessment (Health Care); Patient Acuity; Patient Care Management - economics; Patient Care Management - methods; Quality-Adjusted Life Years; Netherlands
• ISSN: 0392-856X

To evaluate the cost-effectiveness of a tight-control treatment strategy using the handscan (TCHS) compared to using only clinical assessments (TC) and compared to a general non-tight-control treatment strategy (usual care; UC) in early rheumatoid arthritis (RA). Data from 299 early RA patients from the CAMERA trial were used. Clinical outcomes were extrapolated to Quality Adjusted Life Years (QALYs) and costs using a Markov model. Costs and QALYs were compared between the TC and UC treatment strategy arm of the CAMERA trial and a simulated tight-control treatment strategy using the handscan (TCHS). Incremental Cost-Effectiveness Ratios (ICERs) were calculated and several scenario analyses performed. All analyses were performed probabilistically to obtain confidence intervals and costs-effectiveness planes and acceptability curves. In TCHS, €4,660 (95% CI -€11,516 to €2,045) was saved and 0.06 (95% CI 0.01 to 0.11) QALYs were gained when compared to UC, with an ICER of €77,670 saved per QALY gained. Ninety-one percent (91%) of simulations resulted in less costs and more QALYs. TCHS resulted in comparable costs or even limited savings €642 (95% CI -€6,903 to €5,601)) and comparable QALYs to TC. In all scenario analyses, TCHS and TC were found to be cost effective as compared to UC. A tight-control treatment strategy is highly cost-effective compared to a non-tight-control approach in early RA. Using the handscan as a monitoring device might facilitate implementation of tight-control treatment strategy at comparable costs and with comparable effects. This approach should be investigated further.