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• W3133762017 abstract "Rheumatoid arthritis (RA) has become an expensive disease to treat with the introduction of biological therapies in the early 2000s. Therefore, it is of crucial importance that researchers, together with clinicians, search for treatment strategies with the best value for money. That is why we would like to thank the authors of the paper entitled, “Effect on Costs and Quality-adjusted Life-years of Treat-to-target Treatment Strategies Initiating Methotrexate, or Tocilizumab, or Their Combination in Early Rheumatoid Arthritis,” published in this issue of The Journal of Rheumatology , for their honorable attempt1.The authors describe the results of a preplanned cost-effectiveness analysis as a follow-up on the publication of the primary results of the U-Act-Early trial2. This trial was a 2-year, randomized, double-blind, double-dummy, strategy study at 21 rheumatology outpatient departments in the Netherlands, in which 3 treatment strategies were compared: start tocilizumab (TCZ) plus methotrexate (MTX); TCZ plus placebo-MTX (the TCZ arm); and MTX plus placebo-TCZ (the MTX arm). The primary results of the U-Act-Early trial showed a better immediate initiation of TCZ with or without MTX over initiation of MTX alone, but this difference had disappeared after 2 years due to tight control of disease activity in combination with active tapering during the trial, which resulted in comparable TCZ use at study end.In their current paper1, the authors hypothesized that initiating a TCZ-based strategy for patients with early RA using a strict treat-to-target approach and including a clear tapering strategy when in sustained remission, might become cost effective. They were not able to confirm this hypothesis, as they found that estimated from a societal perspective, TCZ + MTX compared to MTX is more expensive and only slightly more effective, whereas there is also a 23% chance that it is less effective [loss in … Address correspondence to Dr. W. Kievit, Radboud UMC, Department for Health Evidence (133), PO Box 9101, 6500HB Nijmegen, the Netherlands. Email: wietske.kievit{at}radboudumc.nl." @default.
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• W3133762017 date "2021-03-01" @default.
• W3133762017 modified "2023-09-28" @default.
• W3133762017 title "If You Want to Perform a Cost-effectiveness Trial, First Do a Modeling Study" @default.
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• W3133762017 doi "https://doi.org/10.3899/jrheum.201430" @default.
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