Physician treatment preferences in rheumatoid arthritis of differing disease severity and activity: the impact of cost on first-line therapy

Arthritis Rheum. 2002 Jun 15;47(3):285-90. doi: 10.1002/art.10456.


Objective: To conduct a pilot study to identify rheumatologists' treatment preferences for first-line rheumatoid arthritis (RA) therapy and determine whether pharmacoeconomic variables modify physician choice(s).

Methods: A questionnaire describing 3 different RA scenarios was mailed to American College of Rheumatology members within 4 geographic regions of the US. Physicians were asked to identify their choice(s) of first-line therapy for each of the cases, first taking cost into consideration, second without considering the influence of cost, and third identifying the therapy that would be chosen for either themselves or a family member.

Results: Three hundred seventy-five questionnaires out of a total of 994 (37.7%) were returned between 3/12/00 and 4/25/00. Hydroxychloroquine was the most commonly cited medication for a mild disease activity/severity presentation, and methotrexate for a moderate-to-severe disease activity/severity presentation. For the severe disease activity/severity presentation, when cost was not considered, 217 (65%) rheumatologists included new disease-modifying antirheumatic drugs (leflunomide, etanercept, and infliximab) in their choice of first-line agents; this number decreased to 47 (14%) when cost was a consideration.

Conclusion: Pharmacoeconomics appear to play a dominant role in rheumatologists' choice of treatment regimens, at times contrary to the physician's perception of the effectiveness of a drug. Future studies should address physician preferences in more depth with respect to cost and its various components.

MeSH terms

  • Antibodies, Monoclonal / economics
  • Antibodies, Monoclonal / therapeutic use
  • Antirheumatic Agents / economics
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / economics
  • Costs and Cost Analysis
  • Etanercept
  • Humans
  • Hydroxychloroquine / economics
  • Hydroxychloroquine / therapeutic use
  • Immunoglobulin G / economics
  • Immunoglobulin G / therapeutic use
  • Immunosuppressive Agents / economics
  • Immunosuppressive Agents / therapeutic use
  • Infliximab
  • Isoxazoles / economics
  • Isoxazoles / therapeutic use
  • Leflunomide
  • Methotrexate / economics
  • Methotrexate / therapeutic use*
  • Pilot Projects
  • Practice Patterns, Physicians' / economics*
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / immunology


  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Isoxazoles
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Hydroxychloroquine
  • Infliximab
  • Leflunomide
  • Etanercept
  • Methotrexate