OBJECTIVES: Whilst the advent of new expensive biotherapies, such as Etanercept for the treatment of rheumatoid arthritis, has improved patient outcomes and reduced the costs of disability and hospitalization, direct drug costs have become the main cost driver for this chronic inflammatory and disabling disorder and pushed overall costs up in the last 20 years. Triple csDMARDs therapy (TT) was proven to be non-inferior to the biotherapy Etanercept in the treatment of rheumatoid arthritis. The aim of this analysis was to estimate the financial consequences of increasing the use of Triple csDMARDs therapy prior to biotherapy in France.

METHODS: A budget impact model was developed to estimate the impact on direct healthcare costs of increasing use of TT for adults with moderate to severe disease activity after a failure of csDMARD monotherapy (Methotrexate) over three years from the French National Health Insurance perspective. French epidemiological data and published trial results were used to calculate the model inputs. We assumed that the annual uptake rates in the eligible incident population (n=2,500) for TT prescription were 50%, 65% and 80% in the first, second and third years. Total costs (€, 2018) were calculated based upon six-monthly assessments of treatment response. Deterministic sensitivity analyses were performed.

RESULTS: The cumulative budget savings over a three-year period following the increase in prescription of TT was €51 million (41% of total costs), with approximately 4875 patients being prescribed TT after csDMARD monotherapy failure. This estimation was very sensitive to the TT uptake rate.

CONCLUSIONS: An increased use of Triple csDMARDs Therapy, prior to biotherapy, is neither clinically inferior nor less safe and would result in a reduction of overall healthcare expenditure in rheumatoid arthritis for the French National Health Insurance. This analysis was limited, since the model did not consider non-compliance and dose de-escalation rates.