Efficacy and cost effectiveness of anti-TNF drugs for reumatoid arthritis treatment

Objective: To submit the latest innovations on the efficacy and cost-effectiveness among the different anti-TNF agents which are currently marketed. Since a growing number of patients are candidates to be treated with these drugs resulting in greater impact on the National Health System. Method: Search was performed in different databases such as PubMed, Embase and Web of Knowledge to identify English and/or Spanish studies, which provided information on the efficacy and cost-effectiveness aspects of various marketed anti-TNF (adalimumab, etanercept, infliximab, certolizumab pegol and golimumab). The search was carried out from 1998 until 2012. Results: We included a total of 15 clinical trials and three meta-analysis to assess, the efficacy of these drugs and six cost-effectiveness studies. The drugs, which achieved better efficacy profile according to the ACR20, ACR50 and HAQ variables, were etanercept and certoizumab pegol. Studies of cost-effectiveness revealed that annual cost per patient was less for etanercept than other alternatives. Conclusions: Further studies are needed to allow a direct comparison among the different anti-TNF, in order to achieve real scale and exempt from possible bias. However the great heterogeneity of the different economical evaluations in this group of drugs makes it difficult for the clinician to decide on choosing the most cost-effective treatment for the patients' therapy