OBJECTIVES: RA is associated with negative impact on patients’ economy and quality of life (QoL). The aim of this analysis is to evaluate the cost-effectiveness of conventional-synthetic-DMARD (Disease-Modifying Antirheumatic Drugs) compared to first biologic-DMARD (bDMARD), on moderate-severe RA patients who start an advanced DMARD in three different perspective scenarios: society, national health system (NHS) and patient, in Spain.

METHODS: This study collected costs (€, year 2022), QALY and effectiveness at baseline (M0) and 12-month (M12) visits in patients who switch from csDMARD to an advanced therapy versus who switch from first bDMARD to an advanced therapy. Financing from three perspectives was considered: resources from society (i.e. work productivity), NHS (i.e. drugs, outpatient visits., hospitalizations) and patient (out-of-pocket). Effectiveness was expressed in Quality-Adjusted Life Years (QALY), calculated from patient´s responses (EQ-5D-3L). Result was presented as incremental cost-utility ratio (ICER) and a probabilistic sensitivity analysis was performed. Three Spanish cost-effective thresholds are considered (a ranged €21,000 to €28,160 per QALY).

RESULTS: The initiation of an advanced therapy in refractory RA from a csDMARD versus bDMARD was cost-effective for NHS perspective (ICER: 2,496) and dominant for society and patient perspective. Probabilistic analysis showed the change from csDMARD vs bDMARD would be cost-effective. Switching from a csDMARD were superior switching alternative from a pharmacoeconomic point of view, a difference (p=0.031) in effectiveness, QALY gained from csDMARD [(0.700 (0.627; 0.773)] vs from bDMARD [(0.565 (0.467; 0.664)], was found.

CONCLUSIONS: Initiating an advanced therapy, in RA refractory patients to treatment with DMARD, is cost-effective from the social, NHS and patient perspectives, being higher the QALY gain for patients who do not respond to csDMARD.