Is a 1-year course of methotrexate in patients with arthralgia at-risk for rheumatoid arthritis costeffective?: A cost-effectiveness analysis of the randomised, placebo-controlled TREAT EARLIER trial

Mulligen, E. van; Bour, S.S.; Goossens, L.M.A.; Jong, P.H.P. de; Rutten-van Mölken, M.; Helm-van Mi, A. van der

doi:doi:10.1136/ard-2024-226286

Objectives: Rheumatoid arthritis (RA) has a considerable disease burden with life-long physical limitations, reduced work productivity and high societal costs. Trials on arthralgia at-risk for RA are therefore conducted, aiming to intercept evolving RA and reduce the disease burden. A 1year course of methotrexate in patients with clinically suspect arthralgia (CSA) caused sustained improvements in subclinical joint inflammation and physical impairments. Since the cost-effectiveness of treatment in CSA has never been investigated, we investigated whether methotrexate is cost-effective. Methods: Cost-effectiveness was assessed using the TREAT EARLIER trial. 236 patients with CSA with subclinical joint inflammation were randomised to 1-year treatment with methotrexate, or placebo, and followed for 2 years. Cost-effectiveness was analysed by computing costs and effects. For costs, both a societal perspective (healthcare-productivity and work-productivity costs) and a healthcare...Show moreObjectives: Rheumatoid arthritis (RA) has a considerable disease burden with life-long physical limitations, reduced work productivity and high societal costs. Trials on arthralgia at-risk for RA are therefore conducted, aiming to intercept evolving RA and reduce the disease burden. A 1year course of methotrexate in patients with clinically suspect arthralgia (CSA) caused sustained improvements in subclinical joint inflammation and physical impairments. Since the cost-effectiveness of treatment in CSA has never been investigated, we investigated whether methotrexate is cost-effective. Methods: Cost-effectiveness was assessed using the TREAT EARLIER trial. 236 patients with CSA with subclinical joint inflammation were randomised to 1-year treatment with methotrexate, or placebo, and followed for 2 years. Cost-effectiveness was analysed by computing costs and effects. For costs, both a societal perspective (healthcare-productivity and work-productivity costs) and a healthcare perspective (healthcare costs only) were used. For effects, quality adjusted life years (QALYs) were used. Results: Treatment increased QALYs by 0.041 (95% CI -0.050 to 0.091), and reduced costs with -4809 (95% CI -12 382 to 2726) over the course of 2 years using a societal perspective, with a probability of 88.1% that treatment was cost-effective. From a healthcare perspective, the cost-difference between treatment and placebo was estimated at -418 (95% CI -1198 to 225). Conclusion: A fixed treatment course in individuals with arthralgia at-risk for RA and MRIdetected subclinical joint inflammation resulted in better work productivity, lower healthcare costs and improved quality of life over the course of 2 years; with the largest gain in productivity costs. This is the first evidence that methotrexate treatment aiming at secondary prevention in arthralgia at-risk for RA is cost-effective.Show less

Leiden University Scholarly Publications

View statistics

Documents

In Collections

Is a 1-year course of methotrexate in patients with arthralgia at-risk for rheumatoid arthritis costeffective? A cost-effectiveness analysis of the randomised, placebo-controlled TREAT EARLIER trial