OBJECTIVE: To perform a modelling study on the cost-effectiveness of three outcome-directed strategies in early @entity309 @entity1 : Strategy 1: starting @entity1500 monotherapy, followed by the addition of LEF, followed by @entity1500 with addition of anti- @entity2874 ; Strategy 2: start with @entity1500 and LEF combination followed by @entity1500 with anti- @entity2874 ; and Strategy 3: immediate start with @entity1500 and anti- @entity2874 . METHODS: A validated Markov model was used to evaluate the cost-effectiveness of the three strategies. Effectiveness of the strategies was determined using daily practice data from two cohorts and used as input parameter in the model. @entity1 treated according to the strategies were matched for baseline 28-joint DAS (DAS-28). Using Monte Carlo simulation, expected costs, quality-adjusted life-years (QALYs) and incremental cost per QALY gained for a 5-year time horizon were calculated following both a health-care and a societal perspective. RESULTS: The percentage of @entity1 in remission and number of QALYs were comparable between the three strategies. Starting with a combination ( @entity1500 plus LEF or anti- @entity2874 ) was more costly than starting with @entity1500 alone. This resulted in an unfavourable incremental cost-effectiveness ratio for starting on anti- @entity2874 vs initially @entity1500 : health-care perspective of    138,028 and from a societal perspective of    136,150 per QALY gained over 5 years. CONCLUSION: In this modelling study, starting with @entity1500 or anti- @entity2874 has comparable effectiveness. However, @entity1613 was far more expensive than starting with @entity1500 monotherapy. Therefore, based on this study, a treatment strategy starting with @entity1500 monotherapy is favoured over a strategy with @entity1500 and anti- @entity2874 right away in early @entity309 @entity1 .

Treatment strategies aiming at remission in early XXXX @entity1 : starting with methotrexate monotherapy is cost-effective.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity2874 :: ('MESH:C536657', 'Disease') :: ['TNF'] @entity1500 :: ('CHEBI:44185', 'Chemical') :: ['MTX'] @entity1613 :: ('MESH:D011230', 'Disease') :: ['initial anti-TNF'] @entity309 :: ('MESH:D001172', 'Disease') :: ['RA']
@entity309 :: (MESH:D001172,Disease) :: ['rheumatoid arthritis']
