The cost-effectiveness of liver biopsy in rheumatoid arthritis patients treated with methotrexate

Arthritis Rheum. 1995 Mar;38(3):326-33. doi: 10.1002/art.1780380306.


Objective: To assess the cost-effectiveness of liver biopsy in monitoring rheumatoid arthritis (RA) patients for methotrexate (MTX)-induced cirrhosis.

Methods: A decision analytic model was used to compare a strategy of no biopsy versus strategies of biopsy after 5 years or 10 years of MTX treatment.

Results: Biopsy after 5 years of MTX treatment had a cost-effectiveness ratio of $1,891,830 per year of life saved, while biopsy after 10 years of treatment had a cost-effectiveness ratio of $52,374 per year of life saved. Sensitivity analyses revealed that the cost-effectiveness of biopsy was most dependent on the probability of cirrhosis.

Conclusion: Liver biopsy to monitor for MTX-induced cirrhosis in RA patients is not cost effective after 5 years of treatment, and even biopsy after 10 years has a high cost.

Publication types

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

MeSH terms

  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / economics
  • Arthritis, Rheumatoid / pathology
  • Biopsy / economics*
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Decision Trees
  • Female
  • Humans
  • Life Expectancy
  • Liver / pathology*
  • Liver Cirrhosis / chemically induced
  • Liver Cirrhosis / pathology*
  • Liver Cirrhosis / prevention & control
  • Methotrexate / adverse effects*
  • Middle Aged
  • Quality of Life
  • Sensitivity and Specificity
  • Value of Life


  • Methotrexate