POS0009 COST-UTILITY ANALYSIS OF THE TREAT EARLIER TRIAL: A ONE YEAR COURSE OF METHOTREXATE IN CLINICALLY SUSPECT ARTHRALGIA PATIENTS IS COST-EFFECTIVE
Authors: E. Van Mulligen, S. Bour, L. Goossens, P. H. P. De Jong, M. Rutten-van Mölken, A. H. M. Van der Helm – van Mil
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) has a considerable disease burden and requires life-long treatment with DMARDs to suppress inflammation. Trials on arthralgia at-risk for RA are therefore conducted, aiming to intercept with evolving RA and reduce the disease burden. The TREAT EARLIER trial recently demonstrated that methotrexate initiated in the pre-arthritis stage of symptoms and subclinical joint inflammation did not prevent RA-development but modified the disease course by sustained improvements in imaging-detected joint inflammation, functioning and workability. Cost-effectiveness in this population has not yet been determined. <h3>Objectives:</h3> To evaluate the cost-effectiveness of a one year course of methotrexate in arthralgia patients at-risk for RA during the course of two years. <h3>Methods:</h3> Cost-effectiveness was analyzed by computing costs and effects. For the costs, a societal perspective was chosen which includes costs due to work productivity losses, and healthcare costs. A healthcare perspective was also used, which included only healthcare costs and no productivity costs. For the effect component, quality adjusted life-years (QALYs) were used. QALYs express the impact of the disease on patients' health over time. Data were used from the TREAT EARLIER trial; a double-blind, placebo-controlled, proof-of-concept trial in adults with clinically suspect arthralgia and subclinical joint-inflammation that were recruited across 13 rheumatology centers in the southwest region of the Netherlands. 236 patients were randomized to either a single intramuscular injection with glucocorticoids and a one year course of methotrexate (up to 25 mg/week), or placebo injection and tablets. Patients were followed for two years. Economic data, collected at baseline and at 4-monthly intervals, concerned data on quality of life measured with the European Quality of Life 5 Dimensions 5 Level Version (EQ5D-5L), from which quality adjusted life years (QALYs) were calculated. Living in perfect health for 1 year corresponds to 1 QALY, while zero QALYs reflects death at baseline. Healthcare costs were measured with the iMTA Medical Consumption Questionnaire (iMCQ), and productivity costs were measured with the Work Productivity and Activity Impairment (WPAI) questionnaire. Bootstrapping with 10,000 replications was used to assess uncertainty. <h3>Results:</h3> Cost of treatment was on average €68 in the treatment arm. Total healthcare costs over 2 years were on average €2,121 for the treatment arm and €2,594 for the placebo arm. Cost due to productivity losses were €30,299 and €34,453, respectively. Average QALYs over 2 years, calculated from the EQ5D-5L index scores, were 1.400 for the treatment arm, and 1.359 for the placebo arm. Resulting from this, cost-utility analysis from a societal perspective showed for the treatment arm €4558 less costs per patient compared to placebo (€-4558, 95%CI -11,291 to 2,431), and 0.0408 (95%CI -0.0499 to 0.0905) more QALYs, respectively (Figure 1A). Using a healthcare perspective, thus excluding work related costs, the difference in costs was €-405 (95% CI -1130 to 248), again indicating less costs for the treatment arm (Figure 1B). <h3>Conclusion:</h3> Treatment resulted in better work productivity, lower healthcare costs and improved quality of life; with the largest gain in the productivity costs. These data suggest that an intramuscular injection with glucocorticoids followed by a one year course of methotrexate in patients with CSA and subclinical inflammation is cost-effective over the course of two years. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>