Shot vs Pill: Methotrexate Choice in Portugal

Researchers in Portugal looked at two ways to give methotrexate for rheumatoid arthritis. One way is a shot under the skin, the other is a pill. They wanted to know which option gives better health outcomes and costs less over a person's lifetime, using the national health service viewpoint.

To do this, they built a computer model that follows patients through different treatment steps. First they try standard disease‑modifying drugs, then they may move to biologics or targeted synthetics. The main comparison looked at starting with the shot versus starting with the pill. A second check examined what happens if someone first tries the pill and later switches to the shot after the pill doesn’t work enough.

The model showed that beginning with the shot adds about a quarter of a year to life and gives roughly half a quality‑adjusted year, while cutting lifetime costs by around eleven thousand euros. When the shot is used after the pill fails, the gains are bigger: about half a year of life, more than one quality‑adjusted year, and a saving of roughly twenty‑six thousand euros.

Using a willingness‑to‑pay of fifty thousand euros per quality‑adjusted year, both scenarios produce a positive net monetary benefit, meaning the shot is judged to be good value for money. The analysis suggests that choosing the subcutaneous form can improve health and save money at the same time.