Background/Purpose: Biologic agents are highly effective in Inflammatory Arthritis (IA) but are extremely expensive. A sustained reduction in biologic dosing frequency would lead to major cost savings. The purpose of this study was to explore whether patients with Inflammatory Arthritis would remain in remission following a reduction in biologic dosing frequency and therefore lead to cost savings.

Methods: This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis (Rheumatoid Arthritis, Psoriatic Arthritis or Ankylosing Spondylitis) being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28<2.6, BASDAI<4) was offered a reduction in the dosing frequency of two commonly used biologic therapies (etanercept 50mg once per fortnight instead of weekly,  adalimumab 40mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6 and 12 months following reduction in dosing frequency. Cost saving was calculated as the difference between the cost of the actual amount of biologic agent used over one year compared with the cost if the dosing interval had not changed.

Results: Seventy nine patients with inflammatory arthritis in remission were recruited. Fifty seven per cent had rheumatoid arthritis (n=45), 13% psoriatic arthritis (n=10) and 30% ankylosing spondylitis (n=24).  Fifty seven per cent (n=45) were taking etanercept and 43% (n=34) adalimumab. The percentage of patients in remission at 12 months was 61% (n=48). Using paired sample t-tests in SPSSv20, no significant difference in measures of disease activity or functional status (DAS28, HAQ or BASDAI scores) was identified from baseline to 12 months in those who remained in remission. This resulted in an actual saving to the state of approximately 300,000 euro over the year.

Conclusion: This small study suggests reduction in biologic dosing frequency is feasible in inflammatory arthritis. The study resulted in considerable cost savings at 1 year. The potential for major cost savings in biologic usage should be pursued further.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/major-cost-savings-associated-with-reduced-biologic-dosing-frequency-in-inflammatory-arthritis/