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Economic Evaluation of Folate Supplementation During Methotrexate Treatment in Rheumatoid Arthritis
MARGRIET HARTMAN, ANNELIES E. van EDE, JOHAN L. SEVERENS, ROLAND F.J.M. LAAN, LEO B.A. van de PUTTE, and GERT JAN van der WILT
ABSTRACT. Methods. An economic evaluation, performed alongside a randomized, double blind, placebo controlled trial with followup of 48 weeks. Patients started MTX with placebo (n = 137), folic acid (n = 133), or folinic acid (n = 141). Outcome measures were drug survival and quality-adjusted life-years (QALY), measured with the EuroQol questionnaire. Both medical and nonmedical costs were analyzed. Results. Drug survival after 48 weeks was 60% for placebo, 81% for folic acid, and 87% for folinic acid. QALY during a 48 week period were 0.55 (95% CI 0.52–0.58) in the placebo group, 0.55 (95% CI 0.52–0.58) in the folic acid group, and 0.58 (95% CI 0.56–0.60) in the folinic acid group. Mean medical costs were US$1398 (placebo), US$1409 (folic acid), and US$1776 (folinic acid). Mean total costs were US$3339, US$3632, and US$3296, respectively. Conclusion. In terms of resource deployment, no statistically significant difference was found between the 3 strategies. The preferred strategy consists of folic acid supplementation because of improved drug survival. (J Rheumatol 2004;31:902-8) Key Indexing Terms:
COST-BENEFIT ANALYSIS
From the Department of Medical Technology Assessment, University Medical Centre, Department of Rheumatology, University Medical Centre, Nijmegen; and Department of Health Organisation, Policy, and Economics, University of Maastricht, Maastricht, The Netherlands. The clinical trial was funded by the Health Care Insurance Board (College voor Zorgverzekeringen) in The Netherlands. M. Hartman, MSc, Researcher, Department of Medical Technology Assessment; A.E. van Ede, MD, PhD, Rheumatologist, Department of Rheumatology; J.L. Severens, PhD, Department of Medical Technology Assessment (currently, Professor, Department of Health Organisation, Policy, and Economics, University of Maastricht); R.F.J.M. Laan, MD, PhD, Rheumatologist, Department of Rheumatology; L.B.A. van de Putte, MD, Professor, Department of Rheumatology; G.J. van der Wilt, PhD, Department of Medical Technology Assessment, University Medical Centre, Nijmegen. Address reprint requests to Dr. M. Hartman, Department of Medical Technology Assessment (253 MTA), University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: M.Moret@mta.umcn.nl Submitted July 28, 2003; revision accepted October 24, 2003. |