Imaging-guided treatment strategy compared to standard care in at-risk individuals for rheumatoid arthritis: a cost-utility analysis
4 affiliations
- 1Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- 2Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- 3Department of Rheumatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- 4Institute for Medical Technology Assessment, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
Abstract
Objective 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.Setting Dutch hospital setting.Participants Individuals at risk of developing RA, stratified by autoantibody status.Interventions Watchful waiting was compared with three imaging strategies—conventional MRI, modified Dixon MRI and ultrasound—combined with early treatment (single intramuscular glucocorticoid injection and 1-year methotrexate course) in patients with positive subclinical inflammation.Outcome measure Incremental cost-effectiveness ratios (ICERs) of the interventions compared with watchful waiting. Cost-effectiveness probabilities were estimated at a willingness-to-pay (WTP) threshold of €50,000 per QALY.Results From a societal perspective, autoantibody-positive patients showed cost savings of €1,183 (-5348 to 2861) (ultrasound) to €1,825 (-8041 to 3861) (modified Dixon MRI). Autoantibody-negative patients had incremental costs from €21 (-3843 to 3856) (conventional MRI) to -€409 (-4499 to 3681) (modified Dixon MRI). QALYs gained ranged from 0.006 (-0.04 to 0.06) to 0.016 (-0.08 to 0.11). Probability of cost-effectiveness was 75%–80% for autoantibody-positive patients and 56%–70% for autoantibody-negative patients at a WTP of €50 000/QALY. Results were less pronounced from a healthcare perspective. Deterministic sensitivity analysis showed the results were robust to most changes in parameters; however, the results were sensitive to extreme changes in parameters related to treatment effects on quality of life (QoL) and productivity and disutilities due to treatment-related side effects.Conclusions Imaging-guided early treatment for arthralgia at-risk for RA may be cost-effective, particularly for autoantibody-positive patients, irrespective of imaging modality. Modified Dixon MRI seems most promising and requires further validation in CSA.Trial registration TREAT EARLIER trial: EudraCT, 2014–004472-35 and the Netherlands Trial Register, NTR4853-trial-NL4599.
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BibTeX
@article{bour2026imagingguided,
title = {{Imaging-guided treatment strategy compared to standard care in at-risk individuals for rheumatoid arthritis: a cost-utility analysis}},
author = {Sterre Bour and Elise Van Mulligen and Lucas Goossens and Pascal Hendrik Pieter de Jong and Annette van der Helm - van Mil and Maureen Rutten-van Molken},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-118495},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118495},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Imaging-guided treatment strategy compared to standard care in at-risk individuals for rheumatoid arthritis: a cost-utility analysis
AU - Sterre Bour
AU - Elise Van Mulligen
AU - Lucas Goossens
AU - Pascal Hendrik Pieter de Jong
AU - Annette van der Helm - van Mil
AU - Maureen Rutten-van Molken
PY - 2026
DA - 2026/10/21
JO - BMJ Open
DO - 10.1136/bmjopen-2026-118495
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-118495
AB - Objective 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.Setting Dutch hospital setting.Participants Individuals at risk of developing RA, stratified by autoantibody status.Interventions Watchful waiting was compared with three imaging strategies—conventional MRI, modified Dixon MRI and ultrasound—combined with early treatment (single intramuscular glucocorticoid injection and 1-year methotrexate course) in patients with positive subclinical inflammation.Outcome measure Incremental cost-effectiveness ratios (ICERs) of the interventions compared with watchful waiting. Cost-effectiveness probabilities were estimated at a willingness-to-pay (WTP) threshold of €50,000 per QALY.Results From a societal perspective, autoantibody-positive patients showed cost savings of €1,183 (-5348 to 2861) (ultrasound) to €1,825 (-8041 to 3861) (modified Dixon MRI). Autoantibody-negative patients had incremental costs from €21 (-3843 to 3856) (conventional MRI) to -€409 (-4499 to 3681) (modified Dixon MRI). QALYs gained ranged from 0.006 (-0.04 to 0.06) to 0.016 (-0.08 to 0.11). Probability of cost-effectiveness was 75%–80% for autoantibody-positive patients and 56%–70% for autoantibody-negative patients at a WTP of €50 000/QALY. Results were less pronounced from a healthcare perspective. Deterministic sensitivity analysis showed the results were robust to most changes in parameters; however, the results were sensitive to extreme changes in parameters related to treatment effects on quality of life (QoL) and productivity and disutilities due to treatment-related side effects.Conclusions Imaging-guided early treatment for arthralgia at-risk for RA may be cost-effective, particularly for autoantibody-positive patients, irrespective of imaging modality. Modified Dixon MRI seems most promising and requires further validation in CSA.Trial registration TREAT EARLIER trial: EudraCT, 2014–004472-35 and the Netherlands Trial Register, NTR4853-trial-NL4599.
SN - 2044-6055
SN - 2044-6055
ER -