Elise van Mulligen, Maureen Rutten-van Mölken, Annette van der Helm-van Mil
{"title":"Early identification of rheumatoid arthritis: does it induce treatment-related cost savings?","authors":"Elise van Mulligen, Maureen Rutten-van Mölken, Annette van der Helm-van Mil","doi":"10.1136/ard-2024-225746","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Early diagnosis and treatment-start is key for rheumatoid arthritis (RA), but the economic effect of an early versus a later diagnosis has never been investigated. We aimed to investigate whether early diagnosis of RA is associated with lower treatment-related costs compared with later diagnosis.</p><p><strong>Methods: </strong>Patients with RA consecutively included in the Leiden Early Arthritis Clinic between 2011 and 2017 were studied (n=431). Symptom duration was defined as the time between symptom onset and first presentation at the outpatient clinic; early treatment start was defined as symptom duration <12 weeks. Information on disease-modifying anti-rheumatic drug use per patient over 5 years was obtained from prescription data from patient records. Prices were used from 2022 and 2012 (proxy of time of prescription) to study the impact of changes in drug costs. Autoantibody-positive and autoantibody-negative RA were studied separately because differences in disease severity may influence costs.</p><p><strong>Results: </strong>Within autoantibody-negative RA, costs were 316% higher in the late compared with the early group (β=4.16 (95% CI 1.57 to 11.1); €4856 vs €1159). When using 2012 prices, results were similar. For autoantibody-positive RA, costs were 19% higher in the late group (€9418 vs €7934, β=1.19, 0.57 to 2.47). This effect was present but smaller when using 2012 prices. Within patients with autoantibody-positive RA using biologicals, late treatment start was associated with 46% higher costs (β=1.46 (0.91 to 2.33)); higher costs were also seen when using 2012 prices.</p><p><strong>Conclusion: </strong>When RA is detected within 12 weeks after symptom onset, treatment-related costs were lower in both autoantibody-negative and autoantibody-positive RA. This study is the first to report how early diagnosis and treatment start impact treatment-related costs.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":null,"pages":null},"PeriodicalIF":20.3000,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of the Rheumatic Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/ard-2024-225746","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Early diagnosis and treatment-start is key for rheumatoid arthritis (RA), but the economic effect of an early versus a later diagnosis has never been investigated. We aimed to investigate whether early diagnosis of RA is associated with lower treatment-related costs compared with later diagnosis.
Methods: Patients with RA consecutively included in the Leiden Early Arthritis Clinic between 2011 and 2017 were studied (n=431). Symptom duration was defined as the time between symptom onset and first presentation at the outpatient clinic; early treatment start was defined as symptom duration <12 weeks. Information on disease-modifying anti-rheumatic drug use per patient over 5 years was obtained from prescription data from patient records. Prices were used from 2022 and 2012 (proxy of time of prescription) to study the impact of changes in drug costs. Autoantibody-positive and autoantibody-negative RA were studied separately because differences in disease severity may influence costs.
Results: Within autoantibody-negative RA, costs were 316% higher in the late compared with the early group (β=4.16 (95% CI 1.57 to 11.1); €4856 vs €1159). When using 2012 prices, results were similar. For autoantibody-positive RA, costs were 19% higher in the late group (€9418 vs €7934, β=1.19, 0.57 to 2.47). This effect was present but smaller when using 2012 prices. Within patients with autoantibody-positive RA using biologicals, late treatment start was associated with 46% higher costs (β=1.46 (0.91 to 2.33)); higher costs were also seen when using 2012 prices.
Conclusion: When RA is detected within 12 weeks after symptom onset, treatment-related costs were lower in both autoantibody-negative and autoantibody-positive RA. This study is the first to report how early diagnosis and treatment start impact treatment-related costs.
目的:早期诊断和开始治疗是类风湿关节炎(RA)的关键所在,但对于早期诊断与晚期诊断的经济效益却从未进行过调查。我们的目的是研究与晚期诊断相比,早期诊断 RA 是否会降低治疗相关费用:研究对象为 2011 年至 2017 年间连续纳入莱顿早期关节炎诊所的 RA 患者(431 人)。症状持续时间定义为从症状出现到首次到门诊就诊的时间;早期治疗开始时间定义为症状持续时间:在自身抗体阴性的RA患者中,晚期治疗组的费用比早期治疗组高316%(β=4.16(95% CI 1.57至11.1);4856欧元对1159欧元)。如果采用2012年的价格,结果类似。对于自身抗体阳性的RA患者,晚期组的费用高出19%(9418欧元对7934欧元,β=1.19,0.57对2.47)。如果采用2012年的价格,这一影响依然存在,但幅度较小。在使用生物制剂的自身抗体阳性的RA患者中,治疗开始晚与46%的高成本相关(β=1.46(0.91至2.33));如果使用2012年的价格,成本也会更高:结论:如果在症状出现后12周内发现RA,自身抗体阴性和自身抗体阳性RA的治疗相关费用均较低。这项研究首次报告了早期诊断和治疗对治疗相关费用的影响。
期刊介绍:
Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.