Cost effectiveness analysis of drug therapies for rheumatoid arthritis.

Abstract We know very little about the relative cost effectiveness of commonly used drug treatments for rheumatoid arthritis (RA), largely due to difficulty obtaining appropriate data and the complexity of the required analysis. There is growing interest in combination therapy for RA. However, it is unclear whether combination therapy will be associated with increased benefit compared to monotherapy, and whether the degree of benefit will offset the anticipated increased costs. We show 3 specific examples derived from a longitudinal database of adults with RA in which we compare the cost effectiveness of longterm drug regimens. Functional status serves as our measure of effectiveness, and we use a conservative estimate of the total annual cost of drug therapy. We also consider the analytic complexity of differences in baseline disease activity. These examples illustrate that in addition to variability in baseline disease activity, there is also substantial variability over time in both effectiveness and costs associated with drug treatment. This variability underscores the importance of considering both the relative effectiveness and costs when making treatment decisions. To make progress in the area of cost effectiveness of longterm treatments for RA and other chronic conditions, it is essential that studies of treatment continue for sufficiently long periods and that relevant cost information be collected in conjunction with measures of effectiveness.