Open Access Research article

Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry

Marloes Vermeer12, Wietske Kievit3, Hillechiena H Kuper2*, Louise MA Braakman-Jansen1, Hein J Bernelot Moens4, Theo R Zijlstra5, Alfons A den Broeder6, Piet LCM van Riel3, Jaap Fransen3 and Mart AFJ van de Laar12

Author Affiliations

1 Arthritis Center Twente, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands

2 Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands

3 Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

4 Department of Rheumatology, Ziekenhuisgroep Twente, Hengelo, The Netherlands

5 Department of Rheumatology, Isala Klinieken, Zwolle, The Netherlands

6 Department of Rheumatology, Maartenskliniek, Nijmegen, The Netherlands

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BMC Musculoskeletal Disorders 2013, 14:350  doi:10.1186/1471-2474-14-350

Published: 13 December 2013



Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA).


We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up.


Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years.


We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.