The cost‐effectiveness of liver biopsy in rheumatoid arthritis patients treated with methotrexate

Abstract
Objective. To assess the cost‐effectiveness of liver biopsy in monitoring rheumatoid arthritis (RA) patients for methotrexate (MTX)–induced cirrhosis.Methods. A decision analytic model was used to compare a strategy of no biopsy versus strategies of biopsy after 5 years or 10 years of MTX treatment.Results. Biopsy after 5 years of MTX treatment had a cost‐effectiveness ratio of $1,891,830 per year of life saved, while biopsy after 10 years of treatment had a cost‐effectiveness ratio of $52,374 per year of life saved. Sensitivity analyses revealed that the cost‐effectiveness of biopsy was most dependent on the probability of cirrhosis.Conclusion. Liver biopsy to monitor for MTX‐induced cirrhosis in RA patients is not cost effective after 5 years of treatment, and even biopsy after 10 years has a high cost.