OBJECTIVES: The aim of this study was to compare the clinical and economic consequences of using subcutaneous methotrexate (Metoject(®)) with respect to oral methotrexate in the management of rheumatoid arthritis (RA) in Spain. METHODS: A cost-effectiveness analysis was performed to compare early treatment of RA using a Markov model. The model allowed us to estimate long term efficacy of RA treatment based on data from the literature and expert opinion, and to combine this data with costs of managing RA in Spain. The perspective of the study was from the National Health System point of view, using a time horizon of 5 years and patient lifetime. All costs were expressed in 2009 euros and a 3% discount rate was applied. RESULTS: The cost (only pharmacologic costs) per quality-adjusted life year (QALY) gained with Metoject(®) went from 25,173 to 35,807€ at 5 years and from 19,056 to 25,351€ for patient lifetime. When direct costs in RA treatment were considered, it was observed that cost-effectiveness at 5 years went from 29,682 to 42,175€/QALY gained, and for patient lifetime from 22,514 to 29,848€/ QALY gained. CONCLUSIONS: Additional costs of Metoject(®) with respect to oral methotrexate would be offset by their improved effectiveness, expressed in QALY, showing that Metoject(®) could be a cost-effective treatment option for RA in the Spanish Health System assuming a spanish threshold.
OBJECTIVES: The aim of this study was to compare the clinical and economic consequences of using subcutaneous methotrexate (Metoject(®)) with respect to oral methotrexate in the management of rheumatoid arthritis (RA) in Spain. METHODS: A cost-effectiveness analysis was performed to compare early treatment of RA using a Markov model. The model allowed us to estimate long term efficacy of RA treatment based on data from the literature and expert opinion, and to combine this data with costs of managing RA in Spain. The perspective of the study was from the National Health System point of view, using a time horizon of 5 years and patient lifetime. All costs were expressed in 2009 euros and a 3% discount rate was applied. RESULTS: The cost (only pharmacologic costs) per quality-adjusted life year (QALY) gained with Metoject(®) went from 25,173 to 35,807€ at 5 years and from 19,056 to 25,351€ for patient lifetime. When direct costs in RA treatment were considered, it was observed that cost-effectiveness at 5 years went from 29,682 to 42,175€/QALY gained, and for patient lifetime from 22,514 to 29,848€/ QALY gained. CONCLUSIONS: Additional costs of Metoject(®) with respect to oral methotrexate would be offset by their improved effectiveness, expressed in QALY, showing that Metoject(®) could be a cost-effective treatment option for RA in the Spanish Health System assuming a spanish threshold.