Abstract
ObjectivesTo 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.MethodsThe 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.ResultsOver 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%.ConclusionsFYB 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.
Highlights
Rheumatoid arthritis (RA) is an autoimmune disease causing chronic inflammation of the joints, often resulting in severe functional disability
[5] Direct costs increased following the introduction of highly effective biologic disease modifying anti-rheumatic drugs (DMARDs), available since 2000 at more than ten times the cost of synthetic DMARDs
[10] While model results have demonstrated that early biologic initiation results in lower costs and improved quality-adjusted life expectancy, [11,12] real-life data are lacking on the mid- to longterm impact of biologics on the direct costs of RA, including the time of initiation of biologic therapy
Summary
Rheumatoid arthritis (RA) is an autoimmune disease causing chronic inflammation of the joints, often resulting in severe functional disability. [5] Direct costs increased following the introduction of highly effective biologic disease modifying anti-rheumatic drugs (DMARDs), available since 2000 at more than ten times the cost of synthetic DMARDs. [6] With the expanded use of biologics, drugs are beginning to replace in-patient care as the greatest source of direct costs, [7,8,9] and differences in access to biologics will likely become the key variable in RA cost of illness across countries. [7] Used in patients with severe disease, biologics are currently not recommended as a first-line therapy due to safety and cost concerns.
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