Early arthritis clinic is cost-effective, improves outcomes and reduces biologic use.

Abstract

There is good evidence that dedicated early arthritis clinics (EACs) improve referral lag time and reduce delay in establishing disease-modifying therapy. However, it remains arguable whether such clinics improve relevant disease outcomes. Nationally, only 57% of units have dedicated EACs. Our rheumatology department established a centralised, patient-focused and multidisciplinary EAC to achieve key financial and clinical outcome targets the department was failing to meet. The EAC aimed to increase the department's capacity to accommodate referrals from general practitioners (GPs) and other sources, decrease the time between diagnosis and starting therapy, establish standardised treatment algorithms and reduce biologic use. The EAC was established in January 2016 and comprised the introduction of a dedicated referral pro forma and an EA educational programme for GPs, pooling of all sources of referral, running of six EACs per week with availability of ultrasound and introduction of a standardised approach to the early initiation of therapy and timely review of treatment outcomes. The introduction of the EAC was associated with improved clinical outcomes (EA patients achieving a Disease Activity Score 28 (DAS28) < 3.2 in 2015, 38.0% [N= 113] vs. 78.5% [N= 220] in 2016) and overall patient experience (mean waiting time for EA patients' first appointment in 2015: 12weeks vs. 2.5weeks in 2016; 94% [N= 167] of patients recommended the rheumatology service in 2016 vs. 74% [N= 100] in 2015). The total costs associated with introducing the EAC were ~ £201,362. Use of biologics decreased from 26.0 to 5.6% between 2015 and 2016, resulting in a cost saving of ~ £394,942. Other cost savings associated with the EAC included reductions in the overall cost/patient seen (2015, £198.88; 2016, £74.98) and not running any premium rate initiative clinics (saving ~ £26,500 in 2016) to meet waiting list targets. Efficiency gains from the introduction of the EACs have improved patients' health and overall satisfaction with their treatment, whilst saving costs for healthcare.