Healthcare commissioners would prefer lower cost alternatives

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pandora charms Few trials have compared them with active non biological treatments,8 9 even though lower cost strategies, such as combinations of synthetic disease modifying drugs, are effective.10 11 12 13 England spends over 600m (820m, $926m) a year on tumour necrosis factor inhibitors, which has a substantial impact on the National Health Service’s budget. Healthcare commissioners would prefer lower cost alternatives provided patients were not disadvantaged.We evaluated this possibility by testing the hypothesis that a lower cost strategy of combinations of synthetic disease modifying drugs achieves outcomes that are not inferior and costs substantially less.MethodsDesignThe TACIT (tumour necrosis factor inhibitors against combination intensive therapy) trial was an open label pragmatic randomised two arm non inferiority trial carried out over 12 months in multiple centres.ParticipantsPatients were recruited from 24 rheumatology clinics in England. We included men and women aged over 18 with disease durations over 12 months who met the 1987 criteria for classification of rheumatoid arthritis and NICE criteria for starting biologics in England. pandora charms

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