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Abstract Number: 1830

Drugs Are the Major Cost Driver of Rheumatoid Arthritis As Soon As the First Year of the Disease: An Economic Analysis Based On the Espoir Cohort Data

Bruno Fautrel1, Sandy Lucier2, Georges Haour2, Hassani Maoulida2, Stephanie Harvard1, Alain Saraux3, Xavier Mariette4, Francis Guillemin5, Isabelle Durand-Zaleski2 and Karine Chevreul2, 1Rheumatology / GRC08-EEMOIS, APHP-Pitie Salpetriere Hospital / UPMC, Paris, France, 2APHP - URC Eco, Paris, France, 3Department of rheumatology and unit of immunology (EA 2216), Université Brest Occidentale, Brest, France, 4Rheumatology, Université Paris-Sud, Le Kremlin Bicetre, France, 5Hopitaux de Brabois, Nancy, France

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: biologic response modifiers, Decision analysis, Economics, Prognostic factors and rheumatoid arthritis (RA)

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Session Information

Session Title: Epidemiology and Health Services Research: Rheumatic Disease Pharmacoepidemiology

Session Type: Abstract Submissions (ACR)

Background/Purpose: Many studies have explored the economic burden of established RA but few data are available about the determinants of costs in early rheumatoid arthritis (RA) cared in real life settings.

The present study aims to describe the determinants of medical costs of early RA during the first 4 years of the disease.

Methods: The ESPOIR cohort is a nationwide cohort that enrolled 813 patients with early arthritis, highly suspect of RA¹, between 2002 and 2005. Data were collected every six months during the first two years then every year. The health resource use was investigated using a validated questionnaire collecting consultations to medical doctors or health professionals, clinical workups, hospitalizations, and treatments. Costs of care (direct costs) were elicited using the national average prices (2007 euros). 

After log-transformation of costs, their determinants were explored by multilevel modeling, using unconditional means models to test for structural effects. To investigate the impact of treatment strategies, patients were classified according to time of biologic initiation: “first-year” (n = 42), “later year” (n = 66) and “never” (n = 440). Univariate correlations were first tested (p ≤ 0.05) so as to preselect a set of variables for multivariate analyses. Then, a multilevel regression analysis was conducted to identify determinants of total direct costs during the first 4 years of follow-up.

Results: Complete data were available for 548 patients (mean age 56 yrs, female 77%, ACPA 46%, RF 50%, ACR/EULAR 2010 83%, mean DAS28 5.1, mean HAQ 1) . Annual mean direct cost per patient was €3,648, with a range from €18 to €53,739. On average, RA drug costs represented 48% of the overall direct costs, and up to 76% for patients receiving biologics.

With respects to total costs, living with a partner and baseline physician certainty of RA diagnosis less than 50% were each associated with lower total costs. Higher baseline HAQ score, increase in HAQ score ³ 0.25 between baseline and the 6-month study visit, and positive rheumatoid factor were associated with higher total costs. In addition, the greatest increases in total costs were associated with “first year” use and “later year” use with approximately 9 and 5-fold increases in total costs, respectively (Table below). Patient socioeconomic status had no impact on total medical costs.

Variables

Multiplicative factor

95% CI

p value

Age at baseline

1.07

1.002; 1.13

0.04

Living with a partner

No

1 

Yes

0.79

0.79; 0.94

0.01

Rheumatoid Factor positivity at baseline

No

 1

Yes

1.20

1.03; 1.40

0.02

HAQ score at baseline

0 – 0.5

0.47

0.34; 0.64

<0.001

0.5 – 1

0.49

0.36; 0.66

<0.001

1 – 2

0.72

0.56; 0.94

0.01

2 – 3

1 

Variation in HAQ score ³ 0.25

between baseline and 6 month visit

 No

1

Yes

1.07

1.04; 1.12

<0.001

Biologic use

Never

 1

First year

9.03

6.83; 11.95

<0.001

Later year

5.30

 4.21; 6.67

<0.001

Physician certainty for RA diagnosis

< 50% at baseline

No

 1

Yes

0.74

0.61; 0.90

<0.001

Intercept

10729€

6794; 16943€

<0.001

Conclusion: As in established RA, biologic use is the main cost driver in rheumatoid arthritis care within the first years of the disease.

1: Combe B and Al. The ESPOIR cohort: a ten-year follow-up of early arthritis in France: methodology and baseline characteristics of the 813 included patients. Joint Bone Spine 2007;74(5):440-5.


Disclosure:

B. Fautrel,
None;

S. Lucier,
None;

G. Haour,
None;

H. Maoulida,
None;

S. Harvard,
None;

A. Saraux,
None;

X. Mariette,
None;

F. Guillemin,
None;

I. Durand-Zaleski,
None;

K. Chevreul,
None.

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