Table 2.

Definition of strategies and how cost-effectiveness can be optimised

Strategy	Definition	Benefit(s)*
Response prediction	To use a predictor for optimising any drug use intervention, such as drug selection, drug dose reduction or drug discontinuation	4
Drug formulary policy	To prescribe b/tsDMARDs in a preferential order for the rheumatology practice, primarily based on effectiveness and safety but in case of equality also on cost-effectiveness	1
Biosimilar/generic drug use	To (allow the) start of or transition to the best value drug variant (biosimilar/generic or originator) of a b/tsDMARD	1
Avoid dose loading	To avoid the loading dose (initial higher dose than maintenance dose) that is part of an authorised dosing	2, 4
Initial lower dose	To use a lower dose than the authorised dose in the maintenance phase	2, 4
Optimising pharmacokinetic exposure	To improve exposure to the b/tsDMARD by influencing pharmacokinetic parameters	2, 4
Combination therapy	To choose for either combined treatment of a b/tsDMARD with a csDMARD or monotherapy of a specific b/tsDMARD	2, 3, 4
Route of administration	To start with or to transition to the most cost-effective route of administration for bDMARDs of which multiple routes are available	2, 3, 4
Drug wastage	To reduce wastage of the b/tsDMARD to reduce total amount of drug needed	2, 3
Medication adherence	To improve the extent to which a person’s medication intake corresponds with agreed treatment decisions with the healthcare provider	3, 4
Disease activity–guided dose optimisation	To gradually reduce drug dosage or lengthen the interval of the b/tsDMARD to the minimal effective dose or discontinuation guided by the disease activity	2, 4
Non-medical drug switching	To switch patients to another more cost-effective b/tsDMARD (within or between classes), excluding biosimilars, to reduce drug costs	1

*1. A direct reduction of drug price per milligram. 2. A lower needed drug quantity (dose/interval). 3. Lower direct additional drug costs. 4. Improved efficacy or safety, or reduced patient burden.

b/tsDMARD, biological and targeted synthetic disease-modifying antirheumatic drug; csDMARD, conventional synthetic disease-modifying antirheumatic drug.