Quality of life and costs for different treatment strategies for rheumatoid arthritis

Rheumatoid arthritis is a chronic, inflammatory, systemic disease. In the past, treatment (strategy) for this disease has changed dramatically, becoming more aggressive and new drugs have become available. Furthermore, closely monitoring the disease and treatment has been advocated. Rheumatoid arthritis has an extensive impact on quality of life and the cost of the disease to society is high. Since rheumatoid arthritis is a chronic disease with life-long treatment, the long-term assessment of cost-effectiveness of new treatment (strategies) frequently implies modeling. This article reviews the assessment of the diagnosis, disease process and outcome (including quality of life and costs) and methodology of cost-effectiveness (modeling) studies in rheumatoid arthritis. Furthermore, it describes the recent trends in the treatment of rheumatoid arthritis and summarizes current evidence regarding the effects on quality of life, costs and cost-effectiveness of these new treatment strategies. Since traditional disease-modifying antirheumatic drug treatment is inexpensive, early aggressive treatment with these drugs is probably cost effective since these strategies do not appear to result in elevated toxicity and are usually found to be effective. Also, closely monitoring patients, if successful, is probably cost effective. The exact place (i.e., as a first-, second- or third-line drug) of new drugs for the treatment of rheumatoid arthritis remains somewhat controversial, since cost-effectiveness analyses have varying results and methodology. Expected future developments in the field are also discussed.