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Mean differences in QALY were small and not significant (TCZ + MTX vs MTX 0.06, 95% CI -0.02 to 0.13; TCZ vs. MTX -0.03, 95% CI -0.05 to 0.11). Limited savings in indirect nonhealthcare costs and productivity loss costs (for TCZ only) were observed, but these did not compensate for the higher medication costs. Sensitivity analyses did not materially change these findings, although lower-priced TCZ, or reserving TCZ as initial therapy for prognostically unfavorable RA patients, improved cost effectiveness considerably but did not indivi