Imaging-guided treatment strategy compared to standard care in at-risk individuals for rheumatoid arthritis: a cost-utility analysis

Abstract: Some individuals present with symptoms before rheumatoid arthritis (RA) develops, and trials suggest that early treatment during this at-risk phase may be effective. This study evaluated the cost-utility of three imaging strategies—conventional MRI, modified Dixon MRI and ultrasound—combined with early treatment compared with watchful waiting in individuals at risk of RA, stratified by autoantibody status.

Design

A decision tree combined with a Markov model was developed to estimate costs and quality-adjusted life years (QALYs) over a 2-year time horizon. Model inputs were derived from the TREAT EARLIER trial for treated patients at risk of developing RA, clinically suspect arthralgia (CSA) cohorts for untreated at-risk patients and the early arthritis clinic for patients with undifferentiated arthritis or RA. Cost-utility analyses were conducted from both the societal- and healthcare perspectives. Probabilistic and deterministic sensitivity analyses were conducted to assess the uncertainty of the results, and several scenarios were explored.