Table 5.
Three-year costs (mean USD per patient), effects (mean QALY gained per patient) and cost effectiveness of six treatment strategies for rheumatoid arthritis using Monte Carlo simulation with 10,000 iterations and WTP threshold of USD 282.
| Strategy | Cost (USD) | Incremental cost | QALYs gained | Incremental effect | ICER |
|---|---|---|---|---|---|
| Strategy 1 (Methotrexate) | 634 | 2.079 | 322 | ||
| Strategy 2 (Methotrexate then TT) | 980 | 243 | 2.150 | −0.012 | Abs dominated1 |
| Strategy 3 (Methotrexate then b/tsDMARD) | 737 | 103 | 2.161 | 0.083 | 1,251 |
| Strategy 4 (Methotrexate then TT then 1-b/tsDMARD) | 1,026 | 289 | 2.177 | 0.016 | 18,359 |
| Strategy 5 (Methotrexate then TT then two consecutive b/tsDMARDs) | 3,063 | 2037 | 2.181 | 0.004 | Ext dominated2 |
| Strategy 6 (Methotrexate then 2 consecutive b/tsDMARDs) | 5,011 | 3,984 | 2.209 | 0.032 | 124,877 |
QALYs, quality-adjusted life years; ICER, incremental cost-effectiveness ratio; WTP, willingness to pay; USD, United States Dollar; TT, triple therapy (methotrexate + sulfasalazine + hydroxychloroquine); b/tsDMARDs, biologic/targeted synthetic disease modifying anti-rheumatic drugs.
1
Abs dominated indicates absolute dominance (costlier and less effective than the next strategy).
2
Ext dominated indicates extended dominance (ICER greater than the next more effective strategy).