Maxime Verhoeven

144 Chapter 7 Conclusion Based on our analyses, early initiation of TCZ, with or without MTX, is not cost-effective compared to MTX initiation in a step-up treat-to-target treatment strategies over 2 or 5 years in early RA patients. Based on sensitivity analyses, subcutaneous administration of lower-priced TCZ, may be cost-effective compared to MTX in the subgroup of patients with high disease activity at start of treatment. REFERENCES 1. Smolen, J. S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann. Rheum. Dis. 76 , 960–977 (2017). 2. Eriksson, J. K. et al. Cost-effectiveness of infliximab versus conventional combination treatment in methotrexate-refractory early rheumatoid arthritis: 2-year results of the register-enriched randomised controlled SWEFOT trial. Ann. Rheum. Dis. 74 , 1094–1101 (2015). 3. van der Hout, W. B. et al. Cost-utility analysis of treatment strategies in patients with recent-onset rheumatoid arthritis. Arthritis Rheum. 61 , 291–299 (2009). 4. de Jong, P. H. P. et al. Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial. Rheumatology. 55 , 2138–2147 (2016). 5. Schipper, L. G. et al. Original article treatment strategies aiming at remission in early rheumatoid arthritis patients: starting with methotrexate monotherapy is cost-effective. Rheumatology 50 , 1320–1330 (2011). 6. Spalding, J. R. & Hay, J. Cost effectiveness of tumour necrosis factor-α Inhibitors as first-line agents in rheumatoid arthritis. Pharmacoeconomics 24 , 1221–1232 (2006). 7. Joensuu, J. T., Huoponen, S., Aaltonen, K. J. & Konttinen, Y. T. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review. PLoS Med. e0119683 (2015) 8. Bijlsma, J. W. J. et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet 388 , 343–355 (2016). 9. Verhoeven, M. M. A. et al. Effectiveness and safety over 3 years after the 2-year U-Act-Early trial of the strategies initiating tocilizumab and / or methotrexate. Rheumatology , 59 , 2325-2333 (2019). 10. Institute for Medical Technology Assessment. Kostenhandleiding . (2016). 11. Pennington, B. & Davis, S. Mapping from the health assessment questionnaire to the EQ-5D : the impact of different algorithms on cost-effectiveness results. Value Heal. 17 , 762–771 (2014). 12. Zorginstituut Nederland. Medicijnkosten.nl. 13. Nair, S. C. et al. Economic evaluation of a tight-control treatment strategy using an imaging device (HandScan) for monitoring joint inflammation in early rheumatoid arthritis. Clin. Exp. Rheumatol. 33 , 831–836 (2015). 14. Brand, J., van Buuren, S., le Cessie, S. & van den Hout, W. Combining multiple imputation and bootstrap in the analysis of cost-effectiveness trial data. Stat. Methods Med. Res. 38 , 210–220 (2019). 15. Salliot, C. & van der Heijde, D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann. Rheum. Dis. 68 , 1100–1104 (2009). 16. Burmester, G. R. et al. Efficacy and safety of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional DMARDs in patients with RA at week 97 (SUMMACTA). Ann. Rheum. Dis. 75 , 68–74 (2016).