Background. TNF- inhibitors have shown to be effective in reducing disease activity and improving the quality of life. Due to the high costs associated with acquisition of this treatment, this study was undertaken to evaluate the ICER of TNF- antagonists (etanercept, adalimumab, and infliximab) in improving the quality of life. Methods. The HAQ and SF-36 were administered at phases 1, 2, and 3, in order to assess the improvement in the QOL. Suppression of disease activity was assessed through the DAS-28. Results. Statistically significant improvements ( ) were noted for the SF-36 and HAQ after 3 months and for the DAS-28 after 6 months of TNF- inhibitor therapy. The mean ICER per 10% improvement in the HAQ, DAS-28, and SF-6D were €1976.5, €2086.5, and €2316.4, respectively, following 6 months of TNF- intervention. Most favorable ICERs were reported from a patient who had to undergo surgical intervention whilst on DMARD therapy. Conclusion. Significant improvement was observed in patients’ quality of life, after a short timeframe of 6 months. Such data is useful information in the light of convincing policy makers, in terms of providing access to the medications to individual patients on national health service schemes. 1. Introduction Rheumatoid arthritis (RA) is a progressive, inflammatory disease which is characterised by inflammation of the joint synovium that could ultimately progress to joint destruction [1, 2]. Due to its chronic, immune-mediated course, long-term treatment with immune-modulatory drugs is generally required [3]. This disabling condition, is thought to affect 0.3–1.2% of the worldwide population [4]. Uncontrolled RA results in progressive joint destruction and functional decline [5]. This disabling condition imposes substantial economic burden through the decreased quality of life (QOL) and loss of productivity [6]. Recent advances in biotechnology and pathogenesis of RA have led to the discovery of biological DMARDs [6]. Biological agents inhibit pro-inflammatory cytokines which are believed to have a crucial role in the inflammatory process within the synovial joint [7]. TNF- inhibitors have proved their clinical efficacy and raised the previous goals of RA treatment [5, 8]. Clinicians nowadays aim to achieve low disease activity or preferably remission and not merely slowing the progression of the disease and controlling symptoms [9]. The discovery of biological agents has led to a drastic shift in the therapeutic approach to RA, leading to a better QOL [10]. Yet, these breakthrough drugs are associated with high procurement
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