Session Type: Abstract Submissions (ACR)
Background/Purpose: Studies from a number of countries suggest that the time between symptom onset and initiation of DMARD therapy in RA patients is still longer than would be considered optimal, or even acceptable. We sought to assess the health economic impact of this delay in an Australian context.
Methods: Delay in initiation of DMARD therapy was estimated from a 2005 study of 96 Australian patients with RA referred to one public and four private rheumatology practices. RA-associated utilities and costs were sourced from published data. Patients not taking and taking DMARD therapy were assumed to have utilities of 0.443 and 0.543, respectively. The annual direct costs of RA, excluding DMARDs, was AUD $3780, and the annual cost of DMARD therapy was $2658. It was conservatively assumed that DMARD therapy did not reduce non-DMARD RA costs (that is, it was $3780 for all patients).
Results: In the 2005 study, the mean time from time of symptom onset to initiation of DMARD therapy was found to be 17.7 months, or 1.48 years. Over the 1.48 years, a mean of 0.65 QALYs would have been lived per patient and $5579 of direct healthcare costs incurred. Had DMARDs been commenced at the time of symptom onset, 0.80 QALYs would have been lived per patient, and $9503 of direct healthcare costs incurred. The differences of 0.15 QALYs and $3924 in direct healthcare costs equated to an incremental cost-effectiveness ratio (ICER) of $26,583 per QALY saved. Up to $4500 of additional costs could be spent per patient to reduce the time to initiation of DMARDs before the ICER breached the arbitrary cut-off of $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: There is considerable delay in the initiation of DMARD therapy among patients with RA, which leads to significant health loss. Reducing the time to initiation of DMARDs represents a cost-effective means of reducing the burden of RA.
S. Van Doornum,
M. D. Reed,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-versus-delayed-initiation-of-disease-modifying-antirheumatic-drugs-in-rheumatoid-arthritis/