Maarten Boers, MSc, MD, PhD
Potential Conflicts of Interest: None disclosed.
Boers M. Cost-Effectiveness of Biologics in Early Rheumatoid Arthritis. Ann Intern Med. 2010;152:334. doi: 10.7326/0003-4819-152-5-201003020-00019
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Published: Ann Intern Med. 2010;152(5):334.
I think the authors and I agree on most of the issues, but we differ in the wording of our conclusions. It is wise to avoid firm conclusions in the face of shaky evidence. A model can never fully replace reality, and we probably need another 10 years of additional experience with biologics to be fully certain of their cost-effectiveness. Nevertheless, when we trust the model, and it points unmistakably in 1 direction, we shouldn't be afraid to clearly communicate what it shows. This is especially important in the area of biologics in rheumatoid arthritis, where intense marketing pressure pushes opinions in the other direction. In their reaction, Dr. Finckh and colleagues use a whole paragraph to describe the uncertainties inherent in modeling and conclude with the sentence I wanted to see in the original article: “Our findings support the use of aggressive DMARDs before biologics in very early rheumatoid arthritis from a cost-effectiveness perspective.” It would have been even better if they had said, “our findings clearly support … ”.
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