Patients with established rheumatoid arthritis (RA) may incur important resource utilisation and work productivity loss, resulting in high costs of illness. Impairment in physical function, which increases with disease duration, is the main variable driving all aspects of these costs. The large variation of costs across administrations is a complex issue and results not only from differences in access to and provision of care but also from absolute differences in the prices for health-care or loss of paid work. Despite the major effects of biologicals on almost all aspects of health, the literature shows that in established RA, the cost-utility ratios are high when compared to adjusting or switching non-biological disease-modifying anti-rheumatic drugs (DMARD) sequences. Until the prices of the biologicals can be reduced, the challenge for optimising the use of biologicals in treatment sequences in RA is to improve selection of patients that would be unresponsive to non-biological DMARDs in an early phase of the disease and identification of patient groups in which biologicals can be successfully stopped.
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