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Xiang L, Graves N, Low AHL, Leung YY, Fong W, Gan WH, Gandhi M, Thumboo J. Cost of lost productivity in inflammatory arthritis and osteoarthritis in the year before and after diagnosis: An inception cohort study. Int J Rheum Dis 2024; 27:e15252. [PMID: 38982887 DOI: 10.1111/1756-185x.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/17/2023] [Accepted: 06/21/2024] [Indexed: 07/11/2024]
Abstract
AIM Existing studies on the cost of inflammatory arthritis (IA) and osteoarthritis (OA) are often cross-sectional and/or involve patients with various disease durations, thus not providing a comprehensive perspective on the cost of illness from the time of diagnosis. In this study, we therefore assessed the cost of lost productivity in an inception cohort of patients with IA and OA in the year before and after diagnosis. METHODS Employment status, monthly income, days absent from work, and presenteeism were collected at diagnosis and 1 year later to estimate the annual costs of unemployment, absenteeism, and presenteeism using human capital approach. Non-parametric bootstrapping was performed to account for the uncertainty of the estimated costs. RESULTS Compared to patients with OA (n = 64), patients with IA (n = 102, including 48 rheumatoid arthritis, 19 spondyloarthritis, 23 psoriatic arthritis, and 12 seronegative IA patients) were younger (mean age: 52.3 vs. 59.5 years) with a greater proportion receiving treatment (99.0% vs. 67.2%) and a greater decrease in presenteeism score (median: 15% vs 10%) 1 year after diagnosis. Annual costs of absenteeism and presenteeism were lower in patients with IA than those with OA both in the year before (USD566 vs. USD733 and USD8,472 vs. USD10,684, respectively) and after diagnosis (USD636 vs. USD1,035 and USD6,866 vs. USD9,362, respectively). CONCLUSION Both IA and OA impose substantial cost of lost productivity in the year before and after diagnosis. The greater improvement in productivity seen in patients with IA suggests that treatment for IA improves work productivity.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Wee-Hoe Gan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Occupational and Environmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Grega D, Kolář J. The Economic Burden of Biological Drugs in Rheumatoid Arthritis Treatment. Value Health Reg Issues 2024; 40:13-18. [PMID: 37972429 DOI: 10.1016/j.vhri.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This article aimed to count and compare treatment's direct (only biological drugs) and indirect (loss of productivity) costs in patients with rheumatoid arthritis from 2019 to 2021. METHODS The friction cost approach was used to establish indirect costs. Elasticity factor values and friction period for the Slovak Republic from 2019 to 2021 were determined. Direct drug costs were calculated based on average prices from 2019 to 2021 and the number of dispensed medication packages. RESULTS The average productivity loss reached €2984.54 in 2019, €3338.46 in 2020, and €3154.01 in 2021. Total indirect costs include productivity loss and sick pay, and from 2019 to 2021 came the values of €8.4 million, €10.1 million, and €8.1 million, respectively. CONCLUSIONS Indirect costs were almost 2.5 to 3 times lower than the biological and targeted treatment costs.
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Affiliation(s)
- Dominik Grega
- Department of Applied Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic.
| | - Jozef Kolář
- Department of Applied Pharmacy, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
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Dejaco C, Mueller T, Zamani O, Kurtz U, Egger S, Resch-Passini J, Totzauer A, Yazdani-Biuki B, Schwingenschloegl T, Peichl P, Kraus A, Naerr GW. A Prospective Study to Evaluate the Impact of Golimumab Therapy on Work Productivity and Activity, and Quality of Life in Patients With Rheumatoid Arthritis, Psoriasis Arthritis and Axial Spondyloarthritis in a Real Life Setting in AUSTRIA. The GO-ACTIVE Study. Front Med (Lausanne) 2022; 9:881943. [PMID: 35721062 PMCID: PMC9201205 DOI: 10.3389/fmed.2022.881943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To analyze real-world evidence on work productivity and daily activity impairment (WPAI) and health-related quality of life (HRQoL) in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) patients treated with golimumab in Austria. Methods This was a prospective, non-interventional, multi-center study conducted in RA, PsA and axSpA patients initiating golimumab between April 2016 and May 2020 in 40 centers in Austria. WPAI, HRQoL (RAQoL, ankylosing spondylitis (AS)QoL and PsAQoL) questionnaires and disease activity (Clinical Disease Activity Index, CDAI, in RA and PsA; Bath Ankylosing Spondylitis Disease Activity Index, BASDAI, in axSpA) were assessed at baseline and months 3, 6, 12, 18, and 24. Association between WPAI and disease activity was tested using linear regression. Results We enrolled 233 patients (RA, n = 95; axSpA, n = 69; PsA, n = 69), 110 patients were followed up to month 24. Mean age was 50.2 ± 14.2 years; 64% were female. Disease activity decreased from baseline to month 24 (RA: CDAI −24.3 ± 13.5; axSpA: BASDAI −4.4 ± 2.1, and PsA: CDAI −21.7 ± 8.5, p < 0.0001, each). Total work productivity impairment (TWPI), activity impairment and presenteeism subscores continuously decreased throughout month 24 in all indications: RA (−58.3 ± 23%, −62.6 ± 23.8% and −61.7 ± 23.3%, respectively as compared to baseline; p < 0.0001, each), axSpA (−34.4 ± 38.3%, p = 0.0117; −60.9 ± 25.9%, and −43.8 ± 26.6%, respectively, p ≤ 0.0001 both) and PsA (−35.8 ± 43.7%, p = 0.0186; −52.3 ± 25.4%, p < 0.0001; and −43.3 ± 33.5%, p = 0.0007, respectively). Absenteeism scores decreased only in RA patients (−9.2 ± 24.9%, p = 0.0234). HRQoL improved between baseline and month 24 (RAQoL: −12.6 ± 7.5; ASQoL: −8.0 ± 4.3; PsAQoL; −8.3 ± 6.4, p < 0.0001, each). TWPI, presenteeism and activity impairment strongly associated with disease activity throughout the study. Conclusions This real-world study confirms the benefit of golimumab on work productivity/daily activity impairment in Austrian RA, PsA, and axSpA patients.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria.,Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Brunico, Italy
| | | | | | | | | | | | | | | | | | - Peter Peichl
- Private Office Prim. Univ. Doz. Dr. Peter Peichl, Vienna, Austria
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Jung SY, Koh JH, Kim KJ, Park YW, Yang HI, Choi SJ, Lee J, Choi CB, Kim WU. Switching from TNFα inhibitor to tacrolimus as maintenance therapy in rheumatoid arthritis after achieving low disease activity with TNFα inhibitors and methotrexate: 24-week result from a non-randomized, prospective, active-controlled trial. Arthritis Res Ther 2021; 23:182. [PMID: 34233727 PMCID: PMC8265052 DOI: 10.1186/s13075-021-02566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Tapering or stopping biological disease-modifying anti-rheumatic drugs has been proposed for patients with rheumatoid arthritis (RA) in remission, but it frequently results in high rates of recurrence. This study evaluates the efficacy and safety of tacrolimus (TAC) as maintenance therapy in patients with established RA in remission after receiving combination therapy with tumor necrosis factor inhibitor (TNFi) and methotrexate (MTX). Methods This 24-week, prospective, open-label trial included patients who received TNFi and MTX at stable doses for ≥24 weeks and had low disease activity (LDA), measured by Disease Activity Score-28 for ≥12 weeks. Patients selected one of two arms: maintenance (TNFi plus MTX) or switched (TAC plus MTX). The primary outcome was the difference in the proportion of patients maintaining LDA at week 24, which was assessed using a logistic regression model. Adverse events were monitored throughout the study period. Results In efficacy analysis, 80 and 34 patients were included in the maintenance and switched arms, respectively. At week 24, LDA was maintained in 99% and 91% of patients in the maintenance and switched arms, respectively (odds ratio, 0.14; 95% confidence interval, 0.01–1.59). Drug-related adverse effects tended to be more common in the switched arm than in the maintenance arm (20.9% versus 7.1%, respectively) but were well-tolerated. Conclusion This controlled study tested a novel treatment strategy of switching from TNFi to TAC in RA patients with sustained LDA, and the findings suggested that TNFi can be replaced with TAC in most patients without the patients experiencing flare-ups for at least 24 weeks. Trial registration Korea CDC CRIS, KCT0005868. Registered 4 February 2021—retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02566-z.
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Affiliation(s)
- Sang Youn Jung
- Division of Rheumatology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, Bucheon St. Mary's Hospital, the Catholic University of Korea, Seoul, South Korea
| | - Ki-Jo Kim
- Division of Rheumatology, Department of Internal Medicine, St. Vincent Hospital, the Catholic University of Korea, Seoul, South Korea
| | - Yong-Wook Park
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hyung-In Yang
- College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, Center for Integrative Rheumatoid Transcriptomics and Dynamics, College of Medicine, the Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
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Fortuna-Reyna BDJ, Peláez-Ballestas I, García-Rodríguez F, Faugier-Fuentes E, Mendieta-Zerón S, Villarreal-Treviño AV, Rosiles-De la Garza SG, Reyes-Cordero G, Jiménez-Hernández S, Guadarrama-Orozco JH, de la O-Cavazos ME, Rubio-Pérez N. Psychosocial and economic impact of rheumatic diseases on caregivers of Mexican children. Pediatr Rheumatol Online J 2021; 19:30. [PMID: 33731150 PMCID: PMC7967951 DOI: 10.1186/s12969-021-00524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pediatric rheumatic disease (PRD) patients and their caregivers face a number of challenges, including the consequences of the PRD in patients and the impact on multiple dimensions of the caregivers' daily lives. The objective of this study is to measure the economic, psychological and social impact that PRD has on the caregivers of Mexican children. METHODS This is a multicenter, cross-sectional study including primary caregivers of children and adolescents with PRD (JIA, JDM and JSLE) during April and November, 2019. A trained interviewer conducted the CAREGIVERS questionnaire, a specific, 28-item multidimensional tool validated to measure the impact on different dimensions of the lives of caregivers. Sociodemographic, clinical, and healthcare system data were collected for further analysis. RESULTS Two hundred participants were recruited (women 169, 84.5%, aged 38 [IQR 33-44] years); 109 (54.5%) cared for patients with JIA, 28 (14%) JDM and 63 (31.5%) JSLE. The healthcare system was found to be determinant on the impact of the disease. The emotional impact was higher in all the participants, regardless of the specific diagnoses. The social dimension showed significant differences regarding PRD, healthcare system, time to reach the center, presence of disability, active disease, cutaneous and systemic manifestations, treatment and partner. Financial and work impacts were more frequent in those caring for JSLE and less so in those with a partner. Family relationships changed in 81 caregivers (25 [12.5%] worsened and 56 [28%] improved). No variables affecting spirituality were found. For caregivers without a partner, the social networks impact increased. CONCLUSION The influence of sociodemographic factors can be devastating on families with children with a PRD. These data will help physicians to identify the areas with the greatest need for intervention to achieve comprehensive care for caregivers and their patients.
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Affiliation(s)
- Brenda de Jesús Fortuna-Reyna
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Ingris Peláez-Ballestas
- grid.414716.10000 0001 2221 3638Rheumatology Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Fernando García-Rodríguez
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Enrique Faugier-Fuentes
- grid.414757.40000 0004 0633 3412Hospital Infantil de México Federico Gómez, Servicio de Reumatología, Mexico City, Mexico
| | - Samara Mendieta-Zerón
- Instituto de Seguridad Social del Estado de México y Municipios, Hospital Regional Toluca, Toluca, Mexico
| | - Ana Victoria Villarreal-Treviño
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Sara Georgina Rosiles-De la Garza
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Greta Reyes-Cordero
- grid.440441.10000 0001 0695 3281Hospital Infantil de Especialidades del Estado de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Sol Jiménez-Hernández
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Jessica Haydee Guadarrama-Orozco
- grid.414757.40000 0004 0633 3412Departamento de Cuidados Paliativos y Calidad de Vida, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Manuel Enrique de la O-Cavazos
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José E. González", Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460, Monterrey, Mexico.
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Hartung W, Sewerin P, Ostendorf B. [Sports and exercise therapy in inflammatory rheumatic diseases]. Z Rheumatol 2021; 80:251-262. [PMID: 33686450 DOI: 10.1007/s00393-021-00970-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/15/2022]
Abstract
Physical therapy has always been a pillar of the treatment of inflammatory rheumatic diseases in addition to targeted drug treatment; nevertheless, it is only established in the treatment guidelines for a few diseases. Within the last two decades the discovery of myokines has uncovered the physiological correlations of the anti-inflammatory effect of physical activity. For rheumatoid arthritis and spondylarthritis, several randomized controlled trials provide sufficient evidence to make well-founded recommendations. For connective tissue diseases (CTD) the data situation is clearly sparser but nevertheless shows that the positive effects of physical activity prevail. In the following article the authors present the most important clinical studies on sport and inflammatory rheumatic diseases and from these derive possible therapeutic recommendations.
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Affiliation(s)
- Wolfgang Hartung
- Asklepios Klinik Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
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Koduri GM, Gullick NJ, Hayes F, Dubey S, Mukhtyar C. Patient perceptions of co-morbidities in inflammatory arthritis. Rheumatol Adv Pract 2021; 5:rkaa076. [PMID: 33615128 PMCID: PMC7884022 DOI: 10.1093/rap/rkaa076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/19/2020] [Indexed: 11/21/2022] Open
Abstract
Objective Longer life expectancy has resulted in people living with an increasing number of co-morbidities. The average individual with inflammatory arthritis has two co-morbidities, which contribute to higher mortality, poorer functional outcomes and increased health-care utilization and cost. A number of studies have investigated the prevalence of co-morbidities, whereas this study was designed to look at patient perspectives. Methods The study comprised two parts: a patient questionnaire and an interview. Individuals with physician-verified inflammatory arthritis along with one or more Charlson co-morbidities were invited to participate. In-depth data were obtained by interviews with 12 willing participants. Results One hundred and forty-six individuals were recruited; 50 (35%) had one co-morbidity, 69 (48%) had two and 25 (17%) had more than four co-morbidities. Seventy-seven individuals (53%) reported that co-morbidities affected their health as much as their arthritis, and 82 (56%) reported dependence on others for activities of daily living. Lack of education was highlighted by 106 (73%) participants. Qualitative data provided further support for the challenges, with participants highlighting the lack of time to discuss complex or multiple problems, with no-one coordinating their care. This, in turn, led to polypharmacy and insufficient discussion around drug and disease interactions, complications and self-help measures. Conclusion This study highlights the challenges for individuals with inflammatory arthritis who suffer with multiple co-morbidities. The challenges result from limited resources or support within the current health-care environments. Individuals highlighted the poor quality of life, which is multifactorial, and the need for better educational strategies and coordination of care to improve outcomes.
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Affiliation(s)
- Gouri M Koduri
- Rheumatology Department, Southend University Hospital, Westcliff-on-Sea
| | - Nicola J Gullick
- Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry
| | - Fiona Hayes
- Rheumatology Department, Southend University Hospital, Westcliff-on-Sea
| | - Shirish Dubey
- Rheumatology Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry
| | - Chetan Mukhtyar
- Rheumatology Department, Norfolk and Norwich University Hospital, Norwich, UK
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Ladhari C, Le Blay P, Vincent T, Larbi A, Rubenstein E, Lopez RF, Jorgensen C, Pers YM. Successful long-term remission through tapering tocilizumab infusions: a single-center prospective study. BMC Rheumatol 2020; 4:5. [PMID: 32161846 PMCID: PMC7047400 DOI: 10.1186/s41927-019-0109-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background Strategic drug therapy for rheumatoid arthritis (RA) patients with prolonged remission is not well defined. According to recent guidelines, tapering biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) may be considered. We aimed to evaluate the effectiveness of long-term maintenance of tocilizumab (TCZ) treatment after the progressive tapering of infusions. Methods We conducted an exploratory, prospective, single-center, open-label study, on RA patients with sustained remission of at least 3 months and treated with TCZ infusions every 4 weeks. The initial re-treatment interval was extended to 6 weeks for the first 3 months. Thereafter, the spacing between infusions was determined by the clinician. Successful long-term maintenance following the tapering of TCZ infusions was defined by patients still treated after two years by TCZ with a minimum dosing interval of 5 weeks. Results Thirteen patients were enrolled in the study. Eight out of thirteen were still treated by TCZ after two years. Successful long-term maintenance was possible in six patients, with four patients maintaining a re-treatment interval of 8-weeks or more. We observed 5 patients with TCZ withdrawal: one showing adverse drug reaction (neutropenia) and four with secondary failure. Patients achieving successful long-term maintenance with TCZ were significantly younger than those with secondary failure (p < 0.05). In addition, RA patients with positive rheumatoid factor and anti-citrullinated peptide antibodies, experienced a significantly greater number of flares during our 2-year follow-up (p < 0.01). Conclusions A progressive tapering of TCZ infusions may be possible for many patients. However, larger studies, including more patients, are needed to confirm this therapeutic option. Trial registration NCT02909998. Date of registration: October 2008.
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Affiliation(s)
- Chayma Ladhari
- 1IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, 371, avenue du doyen Gaston Giraud, 34295 Montpellier, France
| | - Pierre Le Blay
- 1IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, 371, avenue du doyen Gaston Giraud, 34295 Montpellier, France
| | - Thierry Vincent
- Department of Immunology, Saint Eloi University Hospital, 80 rue Augustin Fliche, 34295 Montpellier Cedex 5, France
| | - Ahmed Larbi
- 3Department of Radiology, CHU Nimes, Place du Pr R. Debré, 30029 Nîmes Cedex 9, France
| | - Emma Rubenstein
- 1IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, 371, avenue du doyen Gaston Giraud, 34295 Montpellier, France
| | - Rosanna Ferreira Lopez
- 1IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, 371, avenue du doyen Gaston Giraud, 34295 Montpellier, France
| | - Christian Jorgensen
- 1IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, 371, avenue du doyen Gaston Giraud, 34295 Montpellier, France
| | - Yves-Marie Pers
- 1IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, 371, avenue du doyen Gaston Giraud, 34295 Montpellier, France
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Can we wean patients with inflammatory arthritis from biological therapies? Autoimmun Rev 2019; 18:102399. [PMID: 31639516 DOI: 10.1016/j.autrev.2019.102399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 12/17/2022]
Abstract
Biological therapies have represented a cornerstone in the treatment of immune-mediated inflammatory diseases. Their advent combined with implementation of a treat-to-target approach has meant that remission or low disease activity are now realistic targets for treatment achieved by a significant number of patients. However, biologicals are not risk free and their elevated costs continue to present an important economic burden to national healthcare services. "Can we wean patients with inflammatory arthritis from biological therapies?" Over the last decade this question has become increasingly important as to define the best management strategies in terms of efficacy, safety and economic outcomes. Not surprisingly this has generated an interesting debate as to whether reasons to taper biologics outweigh reasons not to taper and evidence in support of either of these schools of thought is persistently growing. AIM: In this article we reviewed the contents of the relevant session from the 2019 Controversies in Rheumatology and Autoimmunity meeting in Florence.
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Indirect Costs of Rheumatoid Arthritis Depending on Type of Treatment-A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162966. [PMID: 31426543 PMCID: PMC6721219 DOI: 10.3390/ijerph16162966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 12/25/2022]
Abstract
The economic burden of rheumatoid arthritis (RA) on society is high. Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone of therapy. Biological DMARDs are reported to prevent disability and improve quality of life, thus reducing indirect RA costs. We systematically reviewed studies on the relationship between RA and indirect costs comparing biological treatment with standard care. Studies, economic analyses, and systematic reviews published until October 2018 through a MEDLINE search were included. A total of 153 non-duplicate citations were identified, 92 (60%) were excluded as they did not meet pre-defined inclusion criteria. Sixty-one articles were included, 17 of them (28%) were reviews. After full-text review, 28 articles were included, 11 of them were reviews. Costs associated with productivity loss are substantial; in several cases, they may represent over 50% of the total. The most common method of estimation is the Human Capital method. However, certain heterogeneity is observed in the method of estimating, as well as in the resultant figures. Data from included trials indicate that biological therapy is associated with improved labor force participation despite an illness, in which the natural course of disease is defined by progressive work impairment. Use of biological DMARDs may lead to significant indirect cost benefits to society.
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Hresko A, Lin TC, Solomon DH. Medical Care Costs Associated With Rheumatoid Arthritis in the US: A Systematic Literature Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2019; 70:1431-1438. [PMID: 29316377 DOI: 10.1002/acr.23512] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a morbid, mortal, and costly condition without a cure. Treatments for RA have expanded over the last 2 decades, and direct medical costs may differ by types of treatments. There has not been a systematic literature review since the introduction of new RA treatments, including biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS We conducted a systematic literature review with meta-analysis of direct medical costs associated with RA patients cared for in the US since the marketing of the first bDMARD. Standard search strategies and sources were used, and data were extracted independently by 2 reviewers. The methods and quality of included studies were assessed. Total direct medical costs as well as RA-specific costs were calculated using random-effects meta-analysis. Subgroups of interest included Medicare patients and those using bDMARDs. RESULTS We found 541 potentially relevant studies, and 12 articles met the selection criteria. The quality of studies varied: one-third were poor, one-third were fair, and one-third were good. Total direct medical costs were estimated at $12,509 (95% confidence interval [95% CI] 7,451-21,001) for all RA patients using any treatment regimen and $36,053 (95% CI 32,138-40,445) for bDMARD users. RA-specific costs were $3,723 (95% CI 2,408-5,762) for all RA patients using any treatment regimen and $20,262 (95% CI 17,480-23,487) for bDMARD users. CONCLUSION The total and disease-specific direct medical costs for patients with RA is substantial. Among bDMARD users, the cost of RA care is more than half of all direct medical costs.
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Affiliation(s)
- Andrew Hresko
- Tufts University School of Medicine, Boston, Massachusetts
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12
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Mars NJ, Kerola AM, Kauppi MJ, Pirinen M, Elonheimo O, Sokka-Isler T. Patients with rheumatic diseases share similar patterns of healthcare resource utilization. Scand J Rheumatol 2019; 48:300-307. [PMID: 30836033 DOI: 10.1080/03009742.2018.1559878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.
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Affiliation(s)
- N J Mars
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland
| | - A M Kerola
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland.,c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - M J Kauppi
- c Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland.,d School of Medicine , University of Tampere , Tampere , Finland
| | - M Pirinen
- b Institute for Molecular Medicine Finland (FIMM) , University of Helsinki , Helsinki , Finland.,e Helsinki Institute for Information Technology HIIT and Department of Mathematics and Statistics , University of Helsinki , Helsinki , Finland.,f Department of Public Health , University of Helsinki , Helsinki , Finland
| | - O Elonheimo
- a Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - T Sokka-Isler
- g Department of Medicine , Jyväskylä Central Hospital , Jyväskylä , Finland
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Leon L, Abasolo L, Fernandez-Gutierrez B, Jover JA, Hernandez-Garcia C. Costes médicos directos y sus predictores en la cohorte “Variabilidad en el manejo de la artritis reumatoide y las espondiloartritis en España”. ACTA ACUST UNITED AC 2018; 14:4-8. [DOI: 10.1016/j.reuma.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 02/07/2023]
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Nadkarni A, McMorrow D, Patel C, Fowler R, Smith D. Incidence of dose escalation and impact on biologic costs among patients with rheumatoid arthritis treated with three intravenous agents. J Comp Eff Res 2017; 6:671-682. [PMID: 28791875 DOI: 10.2217/cer-2016-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Evaluation of dose escalation and costs among rheumatoid arthritis patients treated with intravenous abatacept, intravenous infliximab or intravenous tocilizumab. MATERIALS & METHODS Adults with rheumatoid arthritis and biologic treatment were identified from the MarketScan® Research databases. Study outcomes included dose escalation, per-patient per-month (PPPM) biologic costs and PPPM all-cause total healthcare costs. Impact of dose escalation on biologic costs was estimated using multivariate analyses. RESULTS The sample included 6181 patients. Infliximab and tocilizumab cohorts had significantly higher likelihood for dose escalation than abatacept cohort; incremental PPPM impacts of dose escalation on costs were statistically significant for each biologic (p < 0.01). CONCLUSION Patients initiating abatacept were least likely to escalate dose and had lowest incremental impact of dose escalation on cost compared with patients with infliximab or tocilizumab.
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Affiliation(s)
- Anagha Nadkarni
- Bristol-Myers Squibb, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
| | - Donna McMorrow
- Truven Health Analytics, 75 Binney Street, Cambridge, MA 02142, USA
| | - Chad Patel
- Bristol-Myers Squibb, 777 Scudders Mill Road, Plainsboro, NJ 08536, USA
| | - Robert Fowler
- Truven Health Analytics, 7700 Old Georgetown Rd, Suite 650, Bethesda, MD 20814, USA
| | - David Smith
- Truven Health Analytics, 7700 Old Georgetown Rd, Suite 650, Bethesda, MD 20814, USA
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Tzanetakos C, Tzioufas A, Goules A, Kourlaba G, Theodoratou T, Christou P, Maniadakis N. Cost-utility analysis of certolizumab pegol in combination with methotrexate in patients with moderate-to-severe active rheumatoid arthritis in Greece. Rheumatol Int 2017; 37:1441-1452. [PMID: 28523420 DOI: 10.1007/s00296-017-3736-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/05/2017] [Indexed: 12/19/2022]
Abstract
We aimed to evaluate the cost-effectiveness of certolizumab pegol (CZP), a pegylated fc-free anti-TNF, as add-on therapy to methotrexate (MTX) versus etanercept, adalimumab, or golimumab in patients with moderate-to-severe active rheumatoid arthritis (RA) not responding to the conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). A Markov model (6-month cycle length) assessed health and cost outcomes of CZP versus other anti-TNFs recommended for RA in Greece over a patient's lifetime. Following discontinuation of first-line anti-TNF, patients switched to second anti-TNF and then to a biologic with another mode of action. Sequential use of csDMARDs followed third biologic. Clinical data and utilities were extracted from published literature. Analysis was conducted from third-party payer perspective in Greece. Costs (drug acquisition, administration, monitoring, and patient management) were considered for 2014. Results presented are incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY). Probabilistic sensitivity analysis (PSA) ascertained robustness of base-case findings. Base-case analysis indicated that CZP+MTX was more costly and more effective compared with Etanercept+MTX (base-case ICER: €3,177 per QALY), whilst versus adalimumab/golimumab, CZP was dominant (less costly, more effective). For all comparisons, CZP treatment resulted in greater improvements in life expectancy and QALYs. PSA indicated that at the willingness-to-pay threshold of €34,000/QALY, CZP+MTX was associated with a 71.6, 97.9, or 99.2% probability of being cost-effective versus etanercept, golimumab, or adalimumab, respectively, in combination with MTX. This analysis demonstrates CZP+MTX to be a cost-effective alternative over Etanercept+MTX and a dominant option over Adalimumab+MTX and Golimumab+MTX for management of RA in Greece.
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Affiliation(s)
- C Tzanetakos
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
| | - A Tzioufas
- Laboratory and Clinic of Pathophysiology, Athens Medical School, Laiko Hospital, Athens, Greece
| | - A Goules
- Laboratory and Clinic of Pathophysiology, Athens Medical School, Laiko Hospital, Athens, Greece
| | - G Kourlaba
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Aghia Sophia Children's Hospital, Athens, Greece
| | | | | | - N Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
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Mallick A, Fautrel B, Sagez F, Sordet C, Javier RM, Petit H, Chatelus E, Rahal N, Gottenberg JE, Sibilia J. Stratégies d’arrêt ou de réduction des biomédicaments dans la polyarthrite rhumatoïde en rémission. Rev Med Interne 2017; 38:256-263. [DOI: 10.1016/j.revmed.2016.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
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Berenbaum F, Pham T, Claudepierre P, de Chalus T, Joubert JM, Saadoun C, Riou França L, Fautrel B. Early non-response to certolizumab pegol in rheumatoid arthritis predicts treatment failure at one year. Data from a randomised phase III clinical trial. Joint Bone Spine 2017; 85:59-64. [PMID: 28214596 DOI: 10.1016/j.jbspin.2017.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 01/05/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare different early clinical criteria of non-response determined at three months as predictors of clinical failure at one year in patients with rheumatoid arthritis starting therapy with certolizumab pegol. METHODS Data were derived from a randomised Phase III clinical trial in patients with rheumatoid arthritis who failed to respond to methotrexate monotherapy. Patients included in this post-hoc analysis were treated with certolizumab pegol (400mg qd reduced to 200mg qd after one month) and with methotrexate. The study duration was twelve months. Response at three months was determined with the American College of Rheumatology-50, Disease Assessment Score-28 ESR, Health Assessment Questionnaire and the Clinical Disease Activity Index. The performance of these measures at predicting treatment failure at twelve months defined by the American College of Rheumatology-50 criteria was determined, using the positive predictive values as the principal evaluation criterion. RESULTS Three hundred and eighty two patients were available for analysis and 225 completed the twelve-month follow-up. At Week 52, 149 (38.1%) patients met the American College of Rheumatology-50 response criterion. Positive predictive values ranged from 81% for a decrease in Health Assessment Questionnaire- Disability index score since baseline >0.22 to 95% for a decrease in Disease Assessment Score-28 score since baseline≥1.2. Sensitivity was≤70% in all cases. Performance of these measures was similar irrespective of the definition of treatment failure at 12months. CONCLUSIONS Simple clinical measures of disease activity can predict future treatment failure reliably and are appropriate for implementing treat-to-target treatment strategies in everyday practice.
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Affiliation(s)
- Francis Berenbaum
- Inserm UMRS 938, Department of Rheumatology, Saint-Antoine Hospital, AP-HP, UPMC, Paris 6 University, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Thao Pham
- Rheumatology Department, Aix-Marseille University, 13284 Marseille, France; Rheumatology Department, Sainte-Marguerite Hospital, AP-HM, 13009 Marseille, France
| | - Pascal Claudepierre
- Laboratoire d'Investigation Clinique (LIC) EA4393, Rheumatology Department, AP-HP, Henri-Mondor hospital, Paris Est Créteil University, 94010 Créteil, France
| | | | | | - Carine Saadoun
- Market Access Department, UCB Pharma, 92700 Colombes, France
| | | | - Bruno Fautrel
- Rheumatology Department, Paris 6 University-GRC UPMC-08, AP-HP, 75005 Paris, France; Rheumatology Department, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
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Fagnani F, Pham T, Claudepierre P, Berenbaum F, De Chalus T, Saadoun C, Joubert JM, Fautrel B. Modeling of the clinical and economic impact of a risk-sharing agreement supporting a treat-to-target strategy in the management of patients with rheumatoid arthritis in France. J Med Econ 2016; 19:812-21. [PMID: 27065315 DOI: 10.1080/13696998.2016.1176576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of a Treat-to-Target strategy with certolizumab pegol in patients with rheumatoid arthritis in the context of a pay-for-performance agreement in which medication costs are refunded in case of discontinuation during the first 3 months of treatment. METHODS The Treat-to-Target strategy consisted of a systematic switch to second-line tumor necrosis factor (TNF)α inhibitor in case of an unmet ACR50 response at 3 months compared to current routine clinical practice. A reference cohort treated first-line with certolizumab pegol according to current practice without systematic switching was considered as the comparator. A decision-tree model was constructed to estimate clinical outcome (health assessment questionnaire-disability index or HAQ-DI score), time spent in ACR50 response (ACR 50), and direct costs of treatment over a 2-year period. HAQ scores were derived from American College of Rheumatology 50 (ACR50) responses. All TNFα inhibitors were assumed to have equivalent efficacy and tolerability. Costs were estimated at 2013 French retail prices (date of the pay-for-performance agreement). RESULTS The mean duration of an ACR50 response was 1.23 years in the Treat-to-Target strategy certolizumab pegol cohort vs 0.98 years in the reference cohort, resulting in a mean gain in HAQ at 24 months of 0.117. The Treat-to-Target strategy with a mix of TNFα inhibitors as second-line therapy was more expensive than the reference strategy in absolute terms, but this difference was entirely offset by the pay-for-performance agreement. The Treat-to-Target strategy was, thus, cost-neutral over a 2-year period after the payback of CZP cost for patients not achieving the target at 3 months. CONCLUSIONS In the context of a pay-for-performance agreement, the management of patients with rheumatoid arthritis using a Treat-to-Target strategy with certolizumab pegol in first line is dominant compared to standard use of this drug in the French setting in 2013.
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Affiliation(s)
| | - Thao Pham
- b Université d'Aix Marseille, Service de Rhumatologie, AP-HM Hôpital Sainte-Marguerite , Marseille , France
| | - Pascal Claudepierre
- c AP-HP, Hôpital Henri Mondor, Service de Rhumatologie, and Université Paris Est Créteil, Laboratoire d'Investigation Clinique (LIC) EA4393 , Créteil , France
| | - Francis Berenbaum
- d AP-HP Hôpital Saint-Antoine, Service de Rhumatologie and Université Paris VI UPMC-INSERM , Paris , France
| | | | | | | | - Bruno Fautrel
- f Université Paris 6 - GRC UPMC-08; AP-HP, Service de Rhumatologie, GH Pitié Salpêtrière , Paris , France
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Wallman JK, Eriksson JK, Nilsson JÅ, Olofsson T, Kristensen LE, Neovius M, Geborek P. Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis: Observational Data from Southern Sweden. J Rheumatol 2016; 43:1292-9. [DOI: 10.3899/jrheum.150617] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/22/2022]
Abstract
Objective.To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA).Methods.Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005–2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients < 65 yrs) were studied in separate regression models, comparing standardized β coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs.Results.Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15–0.27), 0.16 (0.11–0.21), and –0.15 (−0.21 to −0.10) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39–0.48), 0.27 (0.23–0.32), and −0.34 (−0.38 to −0.29) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28).Conclusion.Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.
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van Onna M, Boonen A. The challenging interplay between rheumatoid arthritis, ageing and comorbidities. BMC Musculoskelet Disord 2016; 17:184. [PMID: 27118031 PMCID: PMC4845363 DOI: 10.1186/s12891-016-1038-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/15/2016] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of rheumatoid arthritis (RA) is expected to increase over the next 10 years in the European Union because of the increasing proportion of elderly people. As both RA and ageing are associated with emerging comorbidities such as cardiovascular disease, malignancies and osteoporosis, these factors will have a profound effect on the management of RA. In addition, both increasing age and comorbidities may independently alter commonly used RA-specific outcome measures. Discussion Age-related decline in immune cell functions (immunosenescence), such as a decrease in T-cell function, may contribute to the development of RA, as well as comorbidity. The chronic immune stimulation that occurs in RA may also lead to premature ageing and comorbidity. The interplay between RA, ageing and (emerging) comorbidities is interesting but complex. Cardiovascular disease, lung disease, malignancies, bone and muscle wasting and neuropsychiatric disease all occur more frequently in RA patients as compared to the general population. It is unclear how RA should be managed in ‘today’s world of multiple comorbidities’. Evidence that treatment of RA improves comorbidities is currently lacking, although some promising indirect observations are available. On the other hand, there is limited evidence that medication regularly prescribed for comorbidities, such as statins, might improve RA disease activity. Both ageing and comorbidity have an independent effect on commonly used outcome measures in the RA field, such as the Health Assessment Questionnaire (HAQ) and the clinical disease activity index (CDAI). Prospective studies, that also account for the presence of comorbidity in (elderly) RA patients are therefore urgently needed. To address gaps in knowledge, future research should focus on the complex interdependencies between RA, ageing and comorbidity. In addition, these findings should be integrated into daily clinical practice by developing and testing integrated and coordinated health care services. Adaptation of management recommendations is likely required. Summary The elderly RA patient who also deals with (emerging) comorbidities presents a unique challenge to treating clinicians. A paradigm shift from disease-centered to goal-oriented approach is needed to develop adequate health care services for these patients.
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Affiliation(s)
- Marloes van Onna
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands.
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, School for Public Health and Primary Care (CAPHRI), Maastricht University, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands
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Sangiorgi D, Benucci M, Nappi C, Perrone V, Buda S, Degli Esposti L. Drug usage analysis and health care resources consumption in naïve patients with rheumatoid arthritis. Biologics 2015; 9:119-27. [PMID: 26604680 PMCID: PMC4642803 DOI: 10.2147/btt.s89286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The use of biologic agents has revolutionized the management of rheumatoid arthritis (RA) in the past 2 decades. These biologic agents directly target molecules and cells involved in the pathogenesis of RA. The purpose of this study was to assess the usage of biologic agents in terms of persistence to treatment, dose escalation, and consumption of health care resources (hospitalizations, drugs, and outpatients service) in the real clinical practice in naïve patients with RA. METHODS We conducted a real-world, retrospective, observational cohort study based on data obtained from administrative databases of three Local Health Units in Italy. The population included adults diagnosed with RA who had at least one prescription between January 1, 2009 and December 31, 2011, for a biologic that was approved for treatment of RA. The patients were followed for 12 months after enrollment. The clinical characteristics of the patients enrolled in this study were also investigated in the 1-year period before the index date. The main and secondary endpoints were evaluated only in biologic-naïve patients without switches. The overall health care costs for patients were evaluated. RESULTS A total of 594 patients met the study criteria (mean age 53.5±13.5, female:male ratio =3:1). Thirty-nine percent received etanercept, 25% adalimumab, 14% infliximab, 10% abatacept, 9% tocilizumab, and 3% golimumab. After 1 year of observation, patients showed similar use of other RA-related medication. For the naïve patients without switches, the persistence levels were: 78% for etanercept, 72% for tocilizumab, 71% for adalimumab, 69% for infliximab, and 64% for abatacept. For all agents, dose escalation was 21.4% for infliximab, 11.5% for adalimumab, 5.6% for abatacept, 4% for tocilizumab, and 3.8% for etanercept. The annual costs per treated patients were €12,803 for adalimumab, €11,924 for etanercept, €11,830 for tocilizumab, €11,201 for infliximab, and €10,943 for abatacept. CONCLUSION The role of biologic therapies in the treatment of RA continues to evolve; our study reflects real-world drug utilization data in adult patients with RA. These observations could be used by decision makers to support formulary decisions, although further research is needed using a larger sample to validate these results.
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Affiliation(s)
- Diego Sangiorgi
- CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, Italy
| | - Maurizio Benucci
- Unit of Rheumatology, S. Giovanni di Dio Hospital, Florence, Italy
| | | | - Valentina Perrone
- CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, Italy
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Fautrel B, Den Broeder AA. De-intensifying treatment in established rheumatoid arthritis (RA): Why, how, when and in whom can DMARDs be tapered? Best Pract Res Clin Rheumatol 2015; 29:550-65. [PMID: 26697766 DOI: 10.1016/j.berh.2015.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As more patients with established rheumatoid arthritis (RA) achieve remission or low disease activity, strategies such as tapering and withdrawal of disease-modifying antirheumatic drugs (DMARDs) are being investigated. In several trials, DMARD discontinuation was associated with a higher risk of relapse, ranging from 56% to 87% at 1 year. Tapering, either by dose reduction or by injection spacing, may limit the risk of relapse. Half-dose etanercept (ETN) versus full-dose continuation was not associated with an increased relapse risk at 1 year in two trials. Progressive antitumor necrosis factor injection spacing was shown to be equivalent to full regimen continuation in terms of persistent flare and disease activity at 18 months in one trial, but not in another one. Reintroduction of a DMARD at previous dose/regimen was usually associated with remission re-induction. The risk of relevant structural damage progression was not increased. Safety improvement has not yet been demonstrated. The annual cost reduction when tapering biologic DMARDs (bDMARDs) was 3500-6000 €/patient. Research questions to be addressed include defining flare that requires reinitiation of treatment, such that patients facilitate the maintenance of remission during tapering by timely communication with their rheumatology team.
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Affiliation(s)
- Bruno Fautrel
- Pierre et Marie Curie University - Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), Paris, France; APHP, Rheumatology Department, Pitié Salpêtrière Hospital, F-75013, Paris, France.
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Strand V, Jones TV, Li W, Koenig AS, Kotak S. The impact of rheumatoid arthritis on work and predictors of overall work impairment from three therapeutic scenarios. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/ijr.15.40] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fautrel B, Pham T, Alfaiate T, Gandjbakhch F, Foltz V, Morel J, Dernis E, Gaudin P, Brocq O, Solau-Gervais E, Berthelot JM, Balblanc JC, Mariette X, Tubach F. Step-down strategy of spacing TNF-blocker injections for established rheumatoid arthritis in remission: results of the multicentre non-inferiority randomised open-label controlled trial (STRASS: Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study). Ann Rheum Dis 2015; 75:59-67. [PMID: 26103979 DOI: 10.1136/annrheumdis-2014-206696] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 06/06/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED Tumour necrosis factor (TNF)-blocker tapering has been proposed for patients with rheumatoid arthritis (RA) in remission. OBJECTIVE The trial aims to compare the effect of progressive spacing of TNF-blocker injections (S-arm) to their maintenance (M-arm) for established patients with RA in remission. METHODS The study was an 18-month equivalence trial which included patients receiving etanercept or adalimumab at stable dose for ≥1 year, patients in remission on 28-joint Disease Activity Score (DAS28) for ≥6 months and patients with stable joint damage. Patients were randomised into two arms: maintenance or injections spacing by 50% every 3 months up to complete stop. Spacing was reversed to the previous interval in case of relapse, and eventually reattempted after remission was reachieved. The primary outcome was the standardised difference of DAS28 slopes, based on a linear mixed-effects model (equivalence interval set at ±30%). RESULTS 64 and 73 patients were included in the S-arm and M-arm, respectively, which was less than planned. In the S-arm, TNF blockers were stopped for 39.1%, only tapered for 35.9% and maintained full dose for 20.3%. The equivalence was not demonstrated with a standardised difference of 19% (95% CI -5% to 46%). Relapse was more common in the S-arm (76.6% vs 46.5%, p=0.0004). However, there was no difference in structural damage progression. CONCLUSIONS Tapering was not equivalent to maintenance strategy, resulting in more relapses without impacting structural damage progression. Further studies are needed to identify patients who could benefit from such a strategy associated with substantial cost savings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT00780793; EudraCT identifier: 2007-004483-41.
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Affiliation(s)
- Bruno Fautrel
- Pierre et Marie Curie University-Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), Paris, France APHP, Rheumatology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Thao Pham
- Aix-Marseille University, Marseille, France AP-HM, Rheumatology Department, Sainte Marguerite Hospital, Marseille, France
| | - Toni Alfaiate
- APHP, Department of Epidemiology and Clinical Research, Hôpital Bichat, Paris, France INSERM CIC-EC 1425, Paris, France
| | - Frédérique Gandjbakhch
- Pierre et Marie Curie University-Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), Paris, France APHP, Rheumatology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Violaine Foltz
- Pierre et Marie Curie University-Paris 6, Sorbonne Universités, GRC-08 (EEMOIS), Paris, France APHP, Rheumatology Department, Pitié Salpêtrière Hospital, Paris, France
| | - Jacques Morel
- Rheumatology Department, Montpellier 1 University, Lapeyronie Hospital, Montpellier, France
| | | | - Philippe Gaudin
- Rheumatology Department, Joseph Fourrier University, Sud Hospital, Grenoble, France
| | - Olivier Brocq
- Rheumatology Department, Princess Grace Health Centre, Monaco, Monaco
| | - Elisabeth Solau-Gervais
- University of Poitiers, Poitiers, France Rheumatology Department, La Miletrie Hospital, Poitiers, France
| | - Jean-Marie Berthelot
- University of Nantes, Nantes, France Rheumatology Department, Hotel-Dieu Hospital, Nantes, France
| | | | - Xavier Mariette
- Paris Sud University-Paris 11, Le Kremlin Bicêtre, France AP-HP, Rheumatology Department, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Florence Tubach
- Aix-Marseille University, Marseille, France University Paris Diderot, Sorbonne Paris Cité, UMR 1123, Paris, France
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Kvamme MK, Lie E, Uhlig T, Moger TA, Kvien TK, Kristiansen IS. Cost-effectiveness of TNF inhibitors
vs
synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a Markov model study based on two longitudinal observational studies. Rheumatology (Oxford) 2015; 54:1226-35. [DOI: 10.1093/rheumatology/keu460] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Indexed: 01/18/2023] Open
Abstract
Abstract
Objective. The objective of this study was to estimate the additional costs and health benefits of adding a TNF inhibitor (TNFi) (adalimumab, certolizumab, etanercept, golimumab, infliximab) to a synthetic DMARD (sDMARD), e.g. MTX, in patients with RA.
Methods. We developed the Norwegian RA model as a Markov model simulating 10 years of treatment with either TNFi plus sDMARDs (TNFi strategy) or sDMARDs alone (synthetic strategy). Patients in both strategies started in one of seven health states, based on the Short Form-6 Dimensions (SF-6D). The patients could move to better or worse health states according to transition probabilities. In the TNFi strategy, patients could stay on TNFi (including switch of TNFi), or switch to non-TNFi-biologics (abatacept, rituximab, tocilizumab), sDMARDs or no DMARD. In the synthetic strategy, patients remained on sDMARDs. Data from two observational studies were used for the assessment of resource use and utilities in the health states. Health benefits were evaluated using the EuroQol-5 Dimensions (EQ-5D) and SF-6D.
Results. The Norwegian RA model predicted that 10-year discounted health care costs totalled €124 942 (€475 266 including production losses) for the TNFi strategy and €65 584 (€436 517) for the synthetic strategy. The cost per additionally gained quality-adjusted life-year of adding a TNFi was €92 557 (€60 227 including production losses) using SF-6D and €61 285 (€39 841) using EQ-5D. Including health care costs only, the probability that TNFi treatment was cost-effective was 90% when using EQ-5D, assuming a Norwegian willingness-to-pay level of €67 300.
Conclusion. TNFi treatment for RA is cost-effective when accounting for production losses. Excluding production losses, TNFi treatment is cost-effective using EQ-5D, but not SF-6D.
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Affiliation(s)
- Maria K. Kvamme
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Elisabeth Lie
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Tron A. Moger
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Tore K. Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Ivar S. Kristiansen
- Department of Rheumatology, Diakonhjemmet Hospital, 2 Department of Health Management and Health Economics, University of Oslo and 3 Norwegian Knowledge Centre for the Health Services, Oslo, Norway
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Dadoun S, Guillemin F, Lucier S, Looten V, Saraux A, Berenbaum F, Durand-Zaleski I, Chevreul K, Fautrel B. Work productivity loss in early arthritis during the first 3 years of disease: a study from a French National Multicenter Cohort. Arthritis Care Res (Hoboken) 2014; 66:1310-8. [PMID: 24497394 DOI: 10.1002/acr.22298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 01/28/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess work productivity (WP) loss during the first 3 years of disease in a cohort of patients with early arthritis (EA) diagnosed between 2002 and 2005. METHODS The ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) cohort included 813 EA patients; we included those of working age at baseline in the present study. WP loss was assessed by 3 components: sick leave, permanent disability, and early retirement. The proportion of affected patients and the mean number of days off work were assessed for each component. WP costs were estimated and determinants of positive and extreme costs were assessed by logistic regression models. RESULTS Among the 664 patients included, 81.6% were in the workforce at baseline. During the first 3 years of disease, 45% reported at least 1 sick leave day and 11% reported permanent disability. Only a few patients (1%) reported early retirement. The mean number of days on sick leave due to EA decreased regularly from 44 to 13, whereas the mean number of days on permanent disability tripled from 10 to 33. The mean annual cost was 1,333 (95% confidence interval 1,075-1,620). Sick leave longer than 30 days due to EA before inclusion and a decrease in mental and physical scores of the Medical Outcomes Study Short Form 36 at inclusion were independent determinants of positive and extreme costs in multivariate models. CONCLUSION WP loss is substantial in EA patients and is due to permanent disability before the third year of disease. Work absence and poor mental and physical health status at baseline are major determinants of WP costs.
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Affiliation(s)
- Sabrina Dadoun
- Pitié-Salpétrière Hospital, AP-HP, and Paris VI University, Paris, France
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Abstract
PURPOSE OF REVIEW Autoimmune diseases such as rheumatoid arthritis (RA) pose an increasing, worldwide economic and health burden. Significantly, no cure exists for the majority of autoimmune diseases and consequently treatment is largely aimed at controlling disease symptoms. Therefore, there exists a critical need to develop new approaches that directly address the cause of disease, leading to disease remission and ultimately cure. RECENT FINDINGS The organs, cells and molecules involved in the breach of self-tolerance have been partially defined in experimental models of autoimmunity. However, the broad applicability of this dogma in clinical disease is only partially understood. This gap between analyses of established disease and investigating early disease pathogenesis argues for the need for complementary studies in mice and humans. SUMMARY Through a combination of clinical and experimental systems, novel autoantigens and neoepitopes involved in RA have been revealed. These have clear utility in predisease diagnosis and offer the possibility of antigen-specific immunotherapy. Ongoing experimental and clinical studies, for example using dendritic cell transfer, will facilitate a clearer understanding of the molecules, cells and organs that should be targeted to reinstate immunological tolerance. Antigen-specific immunotherapy therefore offers disease intervention without broad immunosuppression, and most importantly increases the likelihood of achieving true disease remission and cure.
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Kruntorádová K, Klimeš J, Šedová L, Štolfa J, Doležal T, Petříková A. Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis. Value Health Reg Issues 2014; 4:100-106. [DOI: 10.1016/j.vhri.2014.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Barnabe C, Thanh NX, Ohinmaa A, Homik J, Barr SG, Martin L, Maksymowych WP. Effect of remission definition on healthcare cost savings estimates for patients with rheumatoid arthritis treated with biologic therapies. J Rheumatol 2014; 41:1600-6. [PMID: 25028381 DOI: 10.3899/jrheum.131449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. METHODS The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. RESULTS In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. CONCLUSION The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.
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Affiliation(s)
- Cheryl Barnabe
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta.
| | - Nguyen Xuan Thanh
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Arto Ohinmaa
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Joanne Homik
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Susan G Barr
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Liam Martin
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
| | - Walter P Maksymowych
- From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta
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Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis. Joint Bone Spine 2014; 81:287-97. [DOI: 10.1016/j.jbspin.2014.05.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 11/21/2022]
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Gaujoux-Viala C, Gossec L, Cantagrel A, Dougados M, Fautrel B, Mariette X, Nataf H, Saraux A, Trope S, Combe B. Recommandations de la Société française de rhumatologie pour la prise en charge de la polyarthrite rhumatoïde. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rhum.2014.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chevreul K, Haour G, Lucier S, Harvard S, Laroche ML, Mariette X, Saraux A, Durand-Zaleski I, Guillemin F, Fautrel B. Evolution of direct costs in the first years of rheumatoid arthritis: impact of early versus late biologic initiation--an economic analysis based on the ESPOIR cohort. PLoS One 2014; 9:e97077. [PMID: 24811196 PMCID: PMC4014570 DOI: 10.1371/journal.pone.0097077] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/14/2014] [Indexed: 01/10/2023] Open
Abstract
Objectives To estimate annual direct costs of early RA by resource component in an inception cohort, with reference to four distinct treatment strategies: no disease modifying antirheumatic drugs (DMARDs), synthetic DMARDs only, biologic DMARDs in the first year (‘first-year biologic’, FYB), and biologic DMARDs from the second year after inclusion (‘later-year biologic’, LYB); to determine predictors of total and non-DMARD related costs. Methods The ESPOIR cohort is a French multicentric, prospective study of 813 patients with early arthritis. Data assessing RA-related resource utilisation and disease characteristics were collected at baseline, biannually during the first two years and annually thereafter. Costs predictors were determined by generalised linear mixed analyses. Results Over the 4-year follow-up, mean annual direct total costs per treatment strategy group were €3,612 for all patients and €998, €1,922, €14,791, €8,477 respectively for no DMARDs, synthetic DMARDs only, FYB and LYB users. The main predictors of higher costs were biologic use and higher Health Assessment Questionnaire (HAQ) scores at baseline. Being a biologic user led to a higher total cost (FYB Rate Ratio (RR) 7.22, [95% CI 5.59–9.31]; LYB RR 4.39, [95% CI 3.58–5.39]) compared to non-biologic users. Only LYB increased non-DMARD related costs compared to all other patients by 60%. Conclusions FYB users incurred the highest levels of total costs, while their non-DMARD related costs remained similar to non-biologic users, possibly reflecting better RA control.
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Affiliation(s)
- Karine Chevreul
- URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France
- Inserm, ECEVE, U1123, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- * E-mail:
| | - Georges Haour
- URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France
| | - Sandy Lucier
- URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France
| | - Stephanie Harvard
- URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France
- Pierre and Marie Curie University (UPMC) – Paris 6, UPMC GRC 08, Institut Pierre Louis d’Epidémiologie et Santé Publique, Paris, France
| | - Marie-Laure Laroche
- Pharmacology and Toxicology Unit, Centre of Pharmacovigilance-Pharmacoepidemiology CHU, Limoges, France
- Limoges University, EA 6310 HAVAE, Faculty of Medicine, Limoges, France
| | - Xavier Mariette
- Paris XI University, Department of Rheumatology, Bicêtre University Hospital (AP-HP), Le Kremlin Bicêtre, France
| | - Alain Saraux
- Brest University, Department of Rheumatology, La Cavale Blanche Hospital, Brest, France
| | - Isabelle Durand-Zaleski
- URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France
- Inserm, ECEVE, U1123, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France
- Department of Public Health, Henri Mondor-Albert Chenevilier Hospitals (AP-HP), Créteil, France
| | - Francis Guillemin
- Lorraine University, EA 4360 APEMAC; INSERM CIC-EC CIE6, Nancy, France
| | - Bruno Fautrel
- Pierre and Marie Curie University (UPMC) – Paris 6, UPMC GRC 08, Institut Pierre Louis d’Epidémiologie et Santé Publique, Paris, France
- AP-HP, Department of Rheumatology, La Pitié Salpêtrière University Hospital, Paris, France
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Huscher D, Mittendorf T, von Hinüber U, Kötter I, Hoese G, Pfäfflin A, Bischoff S, Zink A. Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis 2014; 74:738-45. [PMID: 24406543 PMCID: PMC4392312 DOI: 10.1136/annrheumdis-2013-204311] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To estimate the changes in direct and indirect costs induced by patients with rheumatoid arthritis (RA) in German rheumatology, between 2002 and 2011. To examine the impact of functional status on various cost domains. To compare the direct costs incurred by patients at working age (18–64 years) to patients at an age of retirement (≥65 years). Methods We analysed data from the National Database of the German Collaborative Arthritis Centres with about 3400 patients each year. Costs were calculated using fixed prices as well as annually updated cost factors. Indirect costs were calculated using the human capital as well as the friction cost approaches. Results There was a considerable increase in direct costs: from €4914 to €8206 in patients aged 18–64, and from €4100 to €6221 in those aged ≥65, attributable to increasing prescription of biologic agents (18–64 years from 5.6% to 31.2%, ≥65 years from 2.8% to 19.2%). This was accompanied by decreasing inpatient treatment expenses and indirect costs due to sick leave and work disability. The total growth of cost, on average, was €2437–2981 for patients at working age, and €2121 for patients at retirement age. Conclusions The increase in treatment costs for RA over the last decade was associated with lower hospitalisation rates, better functional status and a lower incidence of work disability, offsetting a large proportion of risen drug costs. Since the rise in drug costs has manifested a plateau from 2009 onwards, no relevant further increase in total costs for patients with RA treated in German rheumatology is expected.
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Affiliation(s)
- Dörte Huscher
- Epidemiology Unit, German Rheumatism Research Centre, A Leibniz Institute, Berlin, Germany Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Thomas Mittendorf
- Herescon GmbH, Health Economic Research & Consulting, Hannover, Germany
| | | | - Ina Kötter
- Department of Rheumatology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Guido Hoese
- Rheumatologist in Private Practice, Stadthagen, Germany
| | - Andrea Pfäfflin
- Epidemiology Unit, German Rheumatism Research Centre, A Leibniz Institute, Berlin, Germany
| | - Sascha Bischoff
- Epidemiology Unit, German Rheumatism Research Centre, A Leibniz Institute, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, A Leibniz Institute, Berlin, Germany Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
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Brod M, Wolden M, Groleau D, Bushnell DM. Understanding the economic, daily functioning, and diabetes management burden of non-severe nocturnal hypoglycemic events in Canada: differences between type 1 and type 2. J Med Econ 2014; 17:11-20. [PMID: 24199622 DOI: 10.3111/13696998.2013.857676] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the daily functioning, diabetes management, and economic burden of non-severe nocturnal hypoglycemic events (NSNHEs) in Canada and differences in impacts by diabetes type. RESEARCH DESIGN AND METHODS A 20-min web-based survey, with items derived from the literature, expert and patient interviews, assessing the impact of NSNHEs, was administered to patients with self-reported diabetes aged ≥18 having an NSNHE in the past month. RESULTS Two thousand, two hundred and seventy-nine Canadian persons with diabetes were screened with 200 respondents meeting criteria and included in the analysis sample. Out of 87 working respondents, 15 reported on average 3.5 h of lost work (absenteeism). The reduction in work productivity (presenteeism) reported was comparable to the impact of arthritis. Other functional impacts included sleep and daily activities. Additionally, respondents' increased their usual blood sugar monitoring practice, on average, 4.2 (SD = 7.5) extra tests were conducted in the week following the event and reduced their insulin over the following 4.8 days. Increased healthcare utilization was also reported. Increased costs as a result of NSNHE for lost work productivity, increased diabetes management, and resource utilization was CAD 70.67 per person per year in this sample. Limitations of the study include the biases which are associated with a web-based survey and self-reported data. CONCLUSIONS NSNHEs have serious consequences for patients and diabetes management practices. Greater attention to treatments which reduce NSNHEs can have a major impact on improving functioning while reducing the economic burden of diabetes.
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Brod M, Wolden M, Christensen T, Bushnell DM. Understanding the economic burden of nonsevere nocturnal hypoglycemic events: impact on work productivity, disease management, and resource utilization. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:1140-1149. [PMID: 24326167 DOI: 10.1016/j.jval.2013.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Nonsevere hypoglycemic events are common and may occur in one-third of persons with diabetes as often as several times a week. This study's objective was to examine the economic burden of nonsevere nocturnal hypoglycemic events (NSNHEs). METHODS A 20-minute Web-based survey, with items derived from the literature, expert input, and patient interviews, assessing the impact of NSNHEs was administered in nine countries to 18 years and older patients with self-reported diabetes having an NSNHE in the past month. RESULTS A total of 20,212 persons were screened, with 2,108 respondents meeting criteria and included in the analysis sample. The cost of lost work productivity per NSNHE was estimated to be between $10.21 (Germany) and $28.13 (the United Kingdom), representing 3.3 to 7.5 hours of lost work time per event. A reduction in work productivity (presenteeism) was also reported. Compared with respondents' usual blood sugar monitoring practice, on average, 3.6 ± 6.6 extra tests were conducted in the week following the event at a cost of approximately $87.1 per year. Additional costs were also incurred for doctor visits as well as medical care required because of falls or injuries incurred during the NSNHE for an annual cost of $2,111.3 per person per year. When taking into consideration the multiple impacts of NSNHEs for the total sample and the frequency that these events occur, the resulting total annual economic burden was $288,000 or $127 per person per event. CONCLUSIONS NSNHEs have serious consequences for patients. Greater attention to treatments that reduce NSNHEs can have a major impact on reducing the economic burden of diabetes.
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The issue of comparators in economic evaluations of biologic response modifiers in rheumatoid arthritis. Best Pract Res Clin Rheumatol 2013; 26:659-76. [PMID: 23218430 DOI: 10.1016/j.berh.2012.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Over the last decade, a number of biologic response modifiers (BRMs) have emerged and transformed rheumatoid arthritis (RA) management. Due to their relatively high costs, economic evaluations have attempted to determine their place in the RA treatment armamentarium. This article reviews three key areas where changes to the treatment paradigm challenges findings of existing economic evaluations. METHODS We performed a literature search of economic evaluations examining BRMs approved for use in North America for RA. Only economic evaluations that examined relevant direct costs and health outcomes were included. Data were extracted and summarised, then stratified by patient population and comparators. Reported incremental cost-effectiveness ratios (ICERs) were compared across studies. RESULTS It appears that tumour necrosis factor (TNF) alpha inhibitors are less cost effective compared to disease-modifying anti-rheumatic drugs (DMARDs) for first-line treatment. In addition, it appears that treatment with a TNF alpha inhibitor in patients who were refractory to previous DMARD therapies is more cost effective, compared to switching to another DMARD. Finally, after an inadequate response to a TNF alpha inhibitor, it appears that therapy with rituximab is more cost effective than treatment with another TNF alpha inhibitor or abatacept. DISCUSSION It is important to acknowledge that cost effectiveness depends on which comparators are included in the analyses and the evidence for the comparators. The most typical comparator in the studies was traditional DMARDs, mainly methotrexate. However, as more BRMs come into the market and new clinical evidences emerge on the comparative effectiveness of BRMs, new economic evaluations will need to incorporate this information such that reimbursement decisions can be fully informed regarding relative value.
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Thomas R. Dendritic cells and the promise of antigen-specific therapy in rheumatoid arthritis. Arthritis Res Ther 2013; 15:204. [PMID: 23374912 PMCID: PMC3672739 DOI: 10.1186/ar4130] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease resulting from an autoimmune response to self-antigens, leading to inflammation of synovial tissue of joints and subsequent cartilage and bone erosion. Current disease-modifying anti-rheumatic drugs and biologic inhibitors of TNF, IL-6, T cells and B cells block inflammation nonspecifically, which may lead to adverse effects, including infection. They do not generally induce long-term drug-free remission or restoration of immune tolerance to self-antigens, and lifelong treatment is usual. The development of antigen-specific strategies in RA has so far been limited by insufficient knowledge of autoantigens, of the autoimmune pathogenesis of RA and of the mechanisms of immune tolerance in man. Effective tolerance-inducing antigen-specific immunotherapeutic strategies hold promise of greater specificity, of lower toxicity and of a longer-term solution for controlling or even preventing RA. This paper reviews current understanding of autoantigens and their relationship to immunopathogenesis of RA, and emerging therapeutics that aim to leverage normal tolerance mechanisms for implementation of antigen-specific therapy in RA.
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Hagel S, Petersson IF, Bremander A, Lindqvist E, Bergknut C, Englund M. Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population. Ann Rheum Dis 2012; 72:1212-6. [DOI: 10.1136/annrheumdis-2012-202571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PurposeTo study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population.MethodsObservational cohort study. Using Swedish healthcare register data, we identified 3977 Region Skåne residents (mean age in 2001, 62.7 years; 73% women) presenting with RA (International Classification of Diseases-10 codes M05 or M06) in 1998–2001. We randomly sampled two referents from the general population per RA patient matched for age, sex and area of residence. We calculated the year 2001–2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalisations and outpatient clinic visits.ResultsBy the end of the 10-year period, 62% of patients and 74% of referents were still alive and resident in the region. From 2001 to 2010, the ratio (RA cohort/referents) of the mean number of hospitalisations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005) and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy. The absolute reduction in number of hospitalisations was from an annual mean of 0.79 to 0.69 in male patients and from 0.71 to 0.59 in female patients. The corresponding annual mean number of consultations in outpatient physician care by male and female RA patients changed from 9.2 to 7.7 and from 9.9 to 8.7, respectively.ConclusionsDuring the first decade of the 21st century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, overall inpatient and outpatient healthcare utilisation by a cohort of patients with RA decreased relative to the general population.
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Modena V, Bianchi G, Roccatello D. Cost-effectiveness of biologic treatment for rheumatoid arthritis in clinical practice: an achievable target? Autoimmun Rev 2012; 12:835-8. [PMID: 23219766 DOI: 10.1016/j.autrev.2012.11.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The burden of illness of rheumatoid arthritis (RA) falls on patients, families and society through the direct costs, indirect costs, and intangible costs. A large number of RA cost-of-illness studies have been performed in recent decades with discrepant results due to patient heterogeneity, and different health-care organization, employment rate or social support, job opportunities, and methodologies used to calculate the costs. The greatest burden of RA is the indirect and the intangible costs, but how to estimate them remains controversial. The systematic use of traditional disease modifying anti rheumatic drugs has changed the evolution of the disease. However, a considerable improvement in the management of RA has been obtained since the advent of biologic response modifiers. The use of these drugs, which have demonstrated greater efficacy than conventional therapies, have tripled the direct costs of RA, which rose from about € 4000 to roughly € 12,000, in a period of five years, from 2000 to 2005. The present paper is aimed to examine the effects of this change in therapeutic strategy.
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Affiliation(s)
- Vittorio Modena
- Department of Rare, Immunologic, Hematologic Diseases and Transfusion Medicine, Research Center of Immunopathology and Rare Diseases (CMID), Giovanni Bosco Hospital and University of Turin, Italy.
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Healthcare service utilisation costs are reduced when rheumatoid arthritis patients achieve sustained remission. Ann Rheum Dis 2012; 72:1664-8. [DOI: 10.1136/annrheumdis-2012-201918] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Aspects médico-économiques de la polyarthrite rhumatoïde. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2012. [DOI: 10.1016/s0001-4079(19)31711-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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