Background/Purpose:

Several international studies suggest that the time between symptom onset and DMARD initiation in RA patients is longer than is considered optimal. We sought to assess the health economic impact of this delay in an Australian context.

Methods:

The delay in DMARD initiation was estimated from a study of 135 Australian RA patients referred to hospital-based and community-based rheumatologists. RA-associated utilities and costs were sourced from published data. Patients not taking and taking DMARD therapy were assumed to have utilities of 0.59 and 0.64, respectively. The annual direct cost of DMARD therapy was assumed to be AUD$1200, consistent with the most expensive first-line agents in Australia. It was also conservatively assumed that DMARD therapy did not reduce non-DMARD RA costs. (NB: The Australian dollar is near parity with the US dollar.)

Results:

The median time from time of symptom onset to initiation of DMARD therapy was 0.46 years. Over this time a mean of 0.27 quality-adjusted life years (QALYs). Had DMARDs been commenced at symptom onset, 0.30 QALYs would have been lived per patient, and AUD$555 of additional healthcare costs incurred. Hence early initiation of DMARDs would have saved 0.023 QALYs, equating to an incremental cost-effectiveness ratio (ICER) of AUD$24,000 per QALY saved. An additional AUD$600 could be spent per patient to reduce the time to DMARD initiation before the ICER breached the arbitrary cut-off of AUD$50,000 per QALY saved. Our analysis was conservative in it did not consider the long-term health and cost savings associated with avoidance of permanent joint damage.

Conclusion:

The considerable delay in the initiation of DMARD therapy among patients with RA leads to significant health loss. Reducing the time to initiation of DMARDs represents a cost-effective means of reducing the burden of RA

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-health-and-economic-consequences-of-delay-in-starting-disease-modifying-anti-rheumatic-drugs-in-australian-patients-with-early-rheumatoid-arthritis/