van Mulligen Elise, Bour Sterre S, Goossens Lucas M A, de Jong Pascal Hendrik Pieter, Rutten-van Mölken Maureen, van der Helm-van Mil Annette
Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Health Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands.
Ann Rheum Dis. 2025 Jan;84(1):68-76. doi: 10.1136/ard-2024-226286. Epub 2025 Jan 2.
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 1-year 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.
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.
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).
A fixed treatment course in individuals with arthralgia at-risk for RA and MRI-detected 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.
类风湿关节炎（RA）具有相当大的疾病负担，会导致终身身体受限、工作效率降低以及高昂的社会成本。因此开展了针对有RA风险的关节痛的试验，旨在拦截病情进展中的RA并减轻疾病负担。对临床疑似关节痛（CSA）患者使用甲氨蝶呤进行为期1年的治疗，可使亚临床关节炎症和身体损伤持续改善。由于从未研究过CSA治疗的成本效益，我们调查了甲氨蝶呤是否具有成本效益。
使用“尽早治疗”试验评估成本效益。236例有亚临床关节炎症的CSA患者被随机分为接受甲氨蝶呤或安慰剂治疗1年，并随访2年。通过计算成本和效果来分析成本效益。对于成本，采用了社会视角（医疗保健-生产力和工作-生产力成本）和医疗保健视角（仅医疗保健成本）。对于效果，采用质量调整生命年（QALY）。
从社会视角来看，在2年的时间里，治疗使QALY增加了0.041（95%CI -0.050至0.091），并使成本降低了4809欧元（95%CI -12382至2726），治疗具有成本效益的概率为88.1%。从医疗保健视角来看，治疗与安慰剂之间的成本差异估计为418欧元（95%CI -1198至225）。
对于有RA风险且MRI检测到亚临床关节炎症的关节痛患者，进行固定疗程的治疗在2年期间可带来更好的工作效率、更低的医疗保健成本和更高的生活质量；生产力成本收益最大。这是首个表明针对有RA风险的关节痛进行二级预防的甲氨蝶呤治疗具有成本效益的证据。
