Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

A Systematic Review To Appraise the Quality of Cost-Effectiveness Studies of Biologic Agents for the Treatment of Rheumatoid Arthritis.

Lopez-Olivo1,  Maria A., Shaw2,  Yomei, Suarez-Almazor3,  Maria E.

The University of Texas M.D. Anderson Cancer Center, Houston, TX
The University of Texas M.D. Anderson Cancer Center
University of Texas, MD Anderson Cancer Center, Houston, TX


Recently, evidence has shown outstanding advances in the therapeutic approach of rheumatic diseases. The use of cost effectiveness (CE) analyses in this area has increased rapidly due to the elevated costs of the newer agents. We conducted a systematic literature review to describe the methodology reported and integrate findings from publications concerning CE in the treatment of rheumatoid arthritis with biologic agents.


We searched for cost effectiveness studies (including cost-utility) on the use of infliximab, etanercept, adalimumab, golimumab, certolizumab, tocilizumab, rituximab, abatacept and anakinra for the treatment of rheumatoid arthritis, published through September, 2009. Sources included electronic databases (MEDLINE, EMBASE, BIOSIS, etc.) and pertinent websites. Review of 2957 citations revealed 29 CE analyses. Two independent reviewers evaluated development methods of selected studies using the Quality of Health Economic Studies (QHES) tool, which was adapted using the OMERACT criteria for economic evaluations in RA.


Of the 29 publications, 14 reported CE in etanercept, 12 in infliximab, 7 in adalimumab, 3 in abatacept, 2 in rituximab and 1 anakinra. Dates of publication ranged from 2002 to 2009. The studies varied in the clinical trials they cited as evidence for their models (1 to 9 RCTs) and with respect to the costs reported. There was also disparity in how studies were modeled and reported. 82% of the included studies fulfilled 75% or more of the quality of reporting criteria obtaining a "good" quality score. Studies failed to report perspective of the analysis (76%), discounting rate (35%), and pre-specification of groups at the beginning of the study -if estimates came from a subgroup analysis (72%). Studies published after 2006 scored higher in most quality domains than those published before (55%) and also those studies evaluating RA over a time period of >1 year (83%). Studies funded by industry tend to score lower (<75%) than those conducted by agencies (NS). Only 1 study did not specify the source of funding (QHES 81.5%). Figure 1 shows that 80% of the studies funded by industry concluded a cost-effective intervention versus 54% of those funded by agencies (NS).Overall, treatments included in the studies were consider cost-effective (ICERs reported in the studies were within or below 50,000 USD, even after adjusting for inflation and differences in currencies).

Figure 1. CE* per source of funding.

*as described by the authors


Quality scores of CE articles published were rated acceptable. However, several differences in the design, key assumptions, and model structure were observed among studies. There is a need for more uniformity and transparency in the methodology reported in economic evaluations of biologic agents for the treatment of rheumatoid arthritis to help decision makers make better informed decisions.

To cite this abstract, please use the following information:
Lopez-Olivo, Maria A., Shaw, Yomei, Suarez-Almazor, Maria E.; A Systematic Review To Appraise the Quality of Cost-Effectiveness Studies of Biologic Agents for the Treatment of Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :755
DOI: 10.1002/art.28523

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