Rheumatoid arthritis

iMTA has been involved in costing studies, economic evaluations, DCE and early HTA in the field of Rheumatoid Arthritis.

Rheumatoid Arthritis is a costly condition

Rheumatoid arthritis (RA) affects 0.5% to 1.0% of adults in industrialized societies, with 0.5 to 1% incident cases per 100,000 population each year. This chronic, systemic, inflammatory disorder causes erosive damage to articular cartilage and subchondral bone, with joint swelling, deformity, pain, stiffness, and fatigue. Many patients with RA experience diminished health-related quality of life as well as increased disability and cardiovascular and other forms of comorbidity.

Because of RA−related disability, reduced worker productivity, institutionalization, joint-replacement surgery, and increased use of durable medical equipment (DME), RA is a costly condition, accounting for annual health-care expenditures of approximately $128 billion in the United States. Although there is as yet no cure for RA, treatment with disease-modifying antirheumatic drugs (DMARDs) and biological DMARDs (bio-DMARDs) has improved health outcomes.

Key achievements in the field of rheumatoid arthritis

Costing study

iMTA was involved in costing studies in ankylosing spondylitis in three European countries. Mean societal direct costs were 2,640 Euro of which about 80% were direct medical costs. An anlysis of productivity costs and work status highlighted very large differences between Belgium, France and The Netherlands. Analysis showed that living in The Netherlands was associated with a higher chance of being work disabled.

Economic evaluations

iMTA currenlty performs a study on the cost-effectiveness of a protocol-defined treatment strategy targeted at remission in patients with early rheumatoid arthritis. iMTA was further involved in the cost-effectiveness of cognitive-educational treatment of fybromyalgia, which was not found to be cost-effective. iMTA was also involved in a cost-effectiveness analyses of SPA excercise therapy in ankylosing spondylitis (AS). It was concluded that combined spa-exercise therapy besides standard treatment with drugs and weekly group physical therapy is more effective and shows favorable cost-effectiveness and cost-utility ratios compared with standard treatment alone in patients with AS.

Early HTA

Cost-effectiveness results can be used to identify optimal pricing strategies in a given HTA reimbursement context. A good example was our 1-year cost-effectiveness study of four hypothetical add-on diagnostic tests in early inflammatory arthritis patients at risk for reumatoid arthritis. We found that the available headroom of a new test varied between 170 Euro and 350 Euro depending on the test performance and patients that were tested with the add-on test, given a willingness-to-pay threshold of 20,000 Euro per QALY.

Preference measurement / DCE & TTO

iMTA did direct utility measurement using rating scale and standard gamble in patients with ankylosing spondylitis. Loss in health related quality of life was similar for ankylosing spondylitis patients as for fybromialgia patients, when using standard gamble. We used these directly obtained values to better understand health states in this condition. iMTA has published frequently about different preference elicitation techniques and their relative merit.