Background and aims The application of early treat-to-target strategies with biologics has greatly improved the prognosis of rheumatoid arthritis (RA). But the high cost of biologics place the a huge burden on the national health systems. Accumulating evidence suggests thatcombinations with tDMARDs and low-dose prednisone would produce rapid and relevant improvements in signs and symptoms and has been widely accepted for the treatment of RA. Concerns still exist about potential adverse events in the long term. The objective of this study was to analyse the cost-effectiveness of combination of traditional DMARDs and low-dose prednisone compared to biological therapies from the perspective of Chinese society.

Methods A validated lifetime Markov model incorporating the clinical trial data and Chinese unit cost was employed to evaluate the cost-effectiveness of combination strategy (low-dose prednisone and tDMARDs) and three anti-TNFs in active RA patients. Expected costs, quality-adjusted life-years (QALYs) and the incremental cost effectiveness ratios (ICERs) for a one-year time horizon were calculated in Monte Carlo simulation following a societal perspective.

Results In comparison with combination strategy, the ICERs for etanercept, infliximab, and adalimumab were $90488.8, $77295.78, $88961.11 per QALYs. The combination strategy was more cost-effective than any of anti-TNF under the willingness to pay threshold when it was set at 3 times the per capita GDP of China ($7557.04).

Conclusions Based on this study, the treatment starting with low-dose prednisone plus traditional DMARDs is the most cost-effective option for RA patients in the Chinese healthcare setting.