Today, rheumatoid arthritis (RA) estimated 0.24% prevalence with considerable economic costs worldwide. Strategies like anti-TNF (tumour necrosis factor-α) maintenance, dose tapering or withdrawal exhibits unique role in managing RA with improved symptoms, cost-effectiveness as well as obstructing radiographic progression. 

To evaluate health care costs and disease control, Aletaha D and colleagues conducted a 5-year real-world treatment which involves comparison of tumour necrosis factor-α inhibitors (anti-TNFs) adalimumab, etanercept or infliximab maintenance with dose tapering or withdrawal treatments. This estimation was done by using a -year Markov model with a 1-month cycle. The model determined the medical and anti-TNF costs and time (time to loss of disease control and to regaining control after the treatment). For analysis patients with RA who achieved remission ([DAS28] < 2.6) or had low disease activity (LDA; DAS28 < 3.2) were taken. Fourteen studies which included 2309 patients were meta-analyzed to estimate the risk of losing disease control which is adjusted for RA patient type, treatment strategy, anti-TNF and model entry criterion (remission or LDA).

According to analysis, the anti-TNF maintenance obtained comparable 5-year total costs (€67,100-€72,100), which was higher than anti-TNF withdrawal and tapering (€37,900-€59,700 vs €47,500-€59,200). The total costs were higher among established RA patients (€45,900-€72,100) as compared to early RA patients (€37,900-€71,700). The longest time to loss of disease control was noted in maintenance strategy (range, 27.3-47.1 months) whereas shortest in withdrawal strategy (range, 6.9-30.5 months).