csDMARDs vs. TNF inhibitors: which is more cost effective in the treatment of rheumatoid arthritis?

This study investigated the cost-effectiveness of different approaches to treat rheumatoid arthritis.

They found that csDMARDs are as effective as TNF inhibitors and cost less. 

Treating rheumatoid arthritis (RA) involves reducing inflammation. Inflammation leads to painful swelling and joint damage. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. Methotrexate (MTX) is the first line of treatment for RA. Other drugs may be combined with MTX to improve the response. Synthetic DMARDs (csDMARDs) or tumor necrosis factor inhibitors (TNFis) are usually prescribed. Both of these medications are clinically effective. csDMARDs are chemical drugs. TNFis are a type of drug called biologics. Biologic drugs (BDs) are more expensive than csDMARDs. 

Affordability is an important consideration when selecting a medication. Although TNFis are effective, it is not clear if the benefit outweighs the cost compared to csDMARDs.

This study included 205 patients with RA. The trial lasted 12 months. Patients were taking either csDMARDs or TNFis. They were taken in combination with MTX. Patients in the TNFi group were taking one TNFi. Patients in the csDMARD group were taking several DMARDs. Participants with a poor response to DMARDs were offered TNFis. The cost of treatment per participant was measured. The effectiveness of treatment was measured using a standardized questionnaire.

DMARDs were associated with lower cost and better patient outcomes at 12 months. Overall, csDMARD treatment also required less resource use. The results were similar across a number of factors including age and duration of illness. 

The authors concluded that starting treatment with csDMARDs rather than TNFis is more cost-effective and with similar outcomes.

This study investigated a relatively short time period. As RA is a chronic illness, the cost of treatment may be greater over time. More investigation is needed.

If you have any concerns regarding RA treatment, please consult with your physician.