Estimating the cost-effectiveness of 54 weeks of infliximab for rheumatoid arthritis

Am J Med. 2002 Oct 1;113(5):400-8. doi: 10.1016/s0002-9343(02)01243-3.


Purpose: To estimate the cost-effectiveness of infliximab plus methotrexate for active, refractory rheumatoid arthritis.

Methods: We projected the 54-week results from a randomized controlled trial of infliximab into lifetime economic and clinical outcomes using a Markov computer simulation model. Direct and indirect costs, quality of life, and disability estimates were based on trial results; Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) database outcomes; and published data. Results were discounted using the standard 3% rate. Because most well-accepted medical therapies have cost-effectiveness ratios below $50,000 to $100,000 per quality-adjusted life-year (QALY) gained, results below this range were considered to be "cost-effective."

Results: At 3 mg/kg, each infliximab infusion would cost $1393. When compared with methotrexate alone, 54 weeks of infliximab plus methotrexate decreased the likelihood of having advanced disability from 23% to 11% at the end of 54 weeks, which projected to a lifetime marginal cost-effectiveness ratio of $30,500 per discounted QALY gained, considering only direct medical costs. When applying a societal perspective and including indirect or productivity costs, the marginal cost-effectiveness ratio for infliximab was $9100 per discounted QALY gained. The results remained relatively unchanged with variation of model estimates over a broad range of values.

Conclusions: Infliximab plus methotrexate for 54 weeks for rheumatoid arthritis should be cost-effective with its clinical benefit providing good value for the drug cost, especially when including productivity losses. Although infliximab beyond 54 weeks will likely be cost-effective, the economic and clinical benefit remains uncertain and will depend on long-term results of clinical trials.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / economics*
  • Antibodies, Monoclonal / therapeutic use*
  • Antirheumatic Agents / administration & dosage
  • Antirheumatic Agents / economics*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / economics*
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Therapy, Combination
  • Female
  • Humans
  • Infliximab
  • Male
  • Markov Chains
  • Methotrexate / administration & dosage
  • Methotrexate / economics
  • Methotrexate / therapeutic use
  • Middle Aged
  • Quality-Adjusted Life Years
  • Time Factors
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Infliximab
  • Methotrexate