University of Oulu

Tarkiainen, M., Tynjälä, P., Vähäsalo, P. et al. Economic evaluation of infliximab, synthetic triple therapy and methotrexate in the treatment of newly diagnosed juvenile idiopathic arthritis. Pediatr Rheumatol 20, 97 (2022).

Economic evaluation of infliximab, synthetic triple therapy and methotrexate in the treatment of newly diagnosed juvenile idiopathic arthritis

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Author: Tarkiainen, Maarit1,2,3; Tynjälä, Pirjo2,3; Vähäsalo, Paula4,5;
Organizations: 1New Children’s Hospital, Helsinki University Central Hospital, PO Box 705 00029 HUS, Helsinki, Finland
2Pediatric Research Center, University of Helsinki, Helsinki, Finland
3University of Helsinki, Helsinki, Finland
4PEDEGO Research Unit, University of Oulu, Oulu, Finland
5Department of pediatrics, Oulu University Central Hospital, Oulu, Finland
6Department of pediatrics, Kuopio University Hospital, Kuopio, Finland
7School of Pharmacy, University of Eastern Finland, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2023-05-12


Background: Evaluation of costs and short-term cost-effectiveness of infliximab plus methotrexate (IFX + MTX); triple therapy of hydroxychloquine, sulphasalazine, and methotrexate (TRIPLE); or methotrexate monotherapy (MTX) in patients with new-onset polyarticular juvenile idiopathic arthritis (JIA).

Methods: In a prospective multicenter study (ACUTE-JIA), costs and health outcomes of 60 randomized patients with new-onset disease-modifying anti-rheumatic drug (DMARD)-naïve polyarticular JIA were analyzed during the first year. A mapping algorithm was used to obtain utility values from Child Health Assessment Questionnaire (CHAQ). Wallace criteriae were used to assess clinically inactive disease (CID). Linear regression with non-parametric bootstrapping was used to adjust imbalances at baseline.

Results: Using prices for IFX biosimilar, adjusted annual mean (SD) costs of treatment (€) were 21,164 (4158), 12,136 (5286), and 18,300 (8635) on IFX + MTX, TRIPLE, and MTX, respectively. Incremental cost-effectiveness ratio (ICER) for IFX + MTX as compared with TRIPLE or MTX were 3442 € or 678 € per additional month spent in CID. Mean (SD) quality-adjusted life years (QALYs) for IFX + MTX, TRIPLE and MTX were 0.755 (0.065), 0.725 (0.062), and 0.686 (0.124). ICER for IFX + MTX vs TRIPLE was 294,433 €, and for IFX + MTX vs MTX 31,435 € per QALY gained.

Conclusions: In short-term, biosimilar IFX + MTX can be considered cost-effective when compared with MTX alone. TRIPLE was cost-effective when compared with MTX and showed cost advantage when compared with IFX + MTX. Cost per time spent in CID showed similar results than ICER evaluations.

Trial registration: This trial was primarily registered with the Ethical Board of Helsinki District University Hospital (, clinical trial number 211864, and later with, number NCT01015547.

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Series: Pediatric rheumatology
ISSN: 1546-0096
ISSN-E: 1546-0096
ISSN-L: 1546-0096
Volume: 20
Issue: 1
Article number: 97
DOI: 10.1186/s12969-022-00748-w
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: For the current work, MT has received grant funding from The Foundation for Pediatric Research, and The Finnish Medical Foundation.
Dataset Reference: The data that support the findings of this study are available from the ACUTE-JIA investigators, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable requestand with permission of the ACUTE-JIA investigators.
Copyright information: © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.