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Background: Societal decision makers increasingly emphasise their need for evidence based economic analyses to make reimbursement decisions.

Objective: To analyse the cost utility of adalimumab, on both incremental cost and incremental quality adjusted life years (QALYs), versus traditional disease modifying antirheumatic drugs and the other tumour necrosis factor (TNF) antagonists suitable for submission to the Swedish LFN (Pharmaceutical Benefit Board).

Methods: Swedish unit costs and treatment guidelines from a lifetime perspective were implemented. A mathematical model, incorporating data from seven trials, simulated the experiences of 10 000 hypothetical patients with moderate to severe rheumatoid arthritis (RA). The primary outcome measure—QALYs—was derived from utility values calculated from a relationship between the Health Assessment Questionnaire (HAQ) Disability Index …