Stopping tumour necrosis factor inhibitors (TNFis) in rheumatoid arthritis (RA) patients who are in remission or have low disease activity was associated with savings of more than €7,000, according to the results of a Dutch economic evaluation published in Arthritis & Rheumatology (9 May 2018)
Data were collected from a one-year open-label trial comprising 817 patients with longstanding stable controlled RA — 531 patients were randomised to stop TNFis treatment and 286 were randomised to continue treatment. The aim was to evaluate, from a social perspective, the cost utility and cost-effectiveness of withdrawing TNFis compared to continuation.
Patients were assessed at baseline, and at least once every three months after, for a year, by way of laboratory tests and patient-reported outcomes, such as adverse events and days of sick leave.
For ethical reasons, restart of a TNFi was allowed when a flare-up occurred in the stop group.
It was found that withdrawal of TNFis resulted in more than 60% reduction of the total drug cost, although it led to an increase of around 30% in the other healthcare expenditure. Overall, the mean total cost incurred by each patient per year in the continuation group was almost double that in the stop group (€14,740 vs €7,607, respectively).
Compared to continuation, stopping TNFis resulted in a mean annual cost saving of €7,133, a mean loss of quality-adjusted life years (QALYs) of 0.022 and an average of 0.41 more flare-ups.
The researchers calculated that the mean saved cost per QALY lost in the stop group, compared to the continuation group, was €368,269.
They concluded that there was a 100% probability that stopping TNFs is cost effective.
“Despite increasing budget impact over the first 15 years since the introduction of these drugs, evidence on the possibility to discontinue TNFi in the maintenance phase is still sparse — therefore, patients are frequently kept on TNFi indefinitely,” the authors wrote.
“The mean saved cost of €368,269 per QALY lost we found would be cost-effective in The Netherlands,” they added.
 Tran-Duy A, Moghadam M, Voshaar M et al. An economic evaluation of stopping versus continuing TNF-inhibitor treatment in rheumatoid arthritis patients in remission or low disease activity: results from the POET randomized trial. Arth & Rheum 2018. doi: 10.1002/art.40546