The authors note that there is no official willingness-to-accept (WTA) threshold, but they suggest that the mean saved cost of €368,269 per QALY lost would be cost-effective in The Netherlands, given existing data on willingness-to-pay. They suggest the generalisability of their data is likely to be high, as it was based on the largest RCT in this area to date, which was pragmatic with relatively few exclusion criteria. However the findings are only valid for an intervention duration of 12 months. Further research on the response to discontinuation is needed, as patients with different durations of disease and numbers of failed TNF inhibitors may respond differently.