Economic evaluation of infliximab, synthetic triple therapy and methotrexate in the treatment of newly diagnosed juvenile idiopathic arthritis

Pediatr Rheumatol Online J. 2022 Nov 16;20(1):97. doi: 10.1186/s12969-022-00748-w.


Background: Evaluation of costs and short-term cost-effectiveness of infliximab plus methotrexate (IFX + MTX); triple therapy of hydroxychloquine, sulphasalazine, and methotrexate (TRIPLE); or methotrexate monotherapy (MTX) in patients with new-onset polyarticular juvenile idiopathic arthritis (JIA).

Methods: In a prospective multicenter study (ACUTE-JIA), costs and health outcomes of 60 randomized patients with new-onset disease-modifying anti-rheumatic drug (DMARD)-naïve polyarticular JIA were analyzed during the first year. A mapping algorithm was used to obtain utility values from Child Health Assessment Questionnaire (CHAQ). Wallace criteriae were used to assess clinically inactive disease (CID). Linear regression with non-parametric bootstrapping was used to adjust imbalances at baseline.

Results: Using prices for IFX biosimilar, adjusted annual mean (SD) costs of treatment (€) were 21,164 (4158), 12,136 (5286), and 18,300 (8635) on IFX + MTX, TRIPLE, and MTX, respectively. Incremental cost-effectiveness ratio (ICER) for IFX + MTX as compared with TRIPLE or MTX were 3442 € or 678 € per additional month spent in CID. Mean (SD) quality-adjusted life years (QALYs) for IFX + MTX, TRIPLE and MTX were 0.755 (0.065), 0.725 (0.062), and 0.686 (0.124). ICER for IFX + MTX vs TRIPLE was 294,433 €, and for IFX + MTX vs MTX 31,435 € per QALY gained.

Conclusions: In short-term, biosimilar IFX + MTX can be considered cost-effective when compared with MTX alone. TRIPLE was cost-effective when compared with MTX and showed cost advantage when compared with IFX + MTX. Cost per time spent in CID showed similar results than ICER evaluations.

Trial registration: This trial was primarily registered with the Ethical Board of Helsinki District University Hospital ( ), clinical trial number 211864, and later with, number NCT01015547.

Keywords: Biological therapy; Disease-modifying anti-rheumatic drugs; health economic evaluation; Juvenile idiopathic arthritis.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study

MeSH terms

  • Antirheumatic Agents*
  • Arthritis, Juvenile* / drug therapy
  • Biosimilar Pharmaceuticals* / therapeutic use
  • Child
  • Cost-Benefit Analysis
  • Drug Therapy, Combination
  • Humans
  • Infliximab / therapeutic use
  • Methotrexate
  • Prospective Studies
  • Treatment Outcome


  • Methotrexate
  • Infliximab
  • Biosimilar Pharmaceuticals
  • Antirheumatic Agents

Associated data