Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Achieving Sustained Remission in Rheumatoid Arthritis Results in Reduced Long-Term Health Care Costs.
Barnabe1, Cheryl CM, Thanh2, Nguyen Xuan, Ohinmaa3, Arto, Homik3, Joanne, Barr1, Susan G., Martin1, Liam, Maksymowych3, Walter P.
Remission status is of functional benefit to individual rheumatoid arthritis (RA) patients. Achieving remission may require a considerable initial investment when considering costs associated with more frequent physician visits, medication titration and ancillary tests. This investment however could result in long-term cost reduction due to decreased RA morbidity over time. We have linked administrative data with a clinical dataset to examine healthcare system costs of achieving various disease remission states.
We linked data on healthcare utilization (physician visits, outpatient department visits, and hospitalizations) from a provincial administrative database (years 20042009) with clinical data from a prospective cohort of biologic treated patients (n=1,086, mean age 54 years). Remission status was classified according to the DAS28 score by the following categories: i) sustained remission (DAS28 score <=2.6 for >6 months; ii) sustained low disease activity (DAS28 score >2.6 but <=3.2 for >6 months); iii) brief remission (DAS28 score <=2.6 for <=6 months); and iv) never achieving remission (DAS28 >=2.6). We examined both total healthcare costs and costs directly attributable to RA for each category of clinical response, standardized to 2008 Canadian dollars. A propensity score model and quantile regression was used to account for confounding by individual variables affecting healthcare utilization, including specific therapy received, baseline function, smoking, age, sex, disease duration and medical comorbidities.
Median cost differences between patients in sustained remission, sustained low disease activity, and a brief period of remission were not significantly different over the five year study period (Table 1). Patients in sustained remission had significantly reduced total and RA-attributable healthcare costs relative to those patients never achieving a remission period over the five years, with a savings of $616 (95%CI 901141; p<0.001) per patient. Costs directly attributable to RA were constant in all remission categories at approximately 25%.
Table 1. Median Study Period Healthcare Costs per Individual, by Remission Status
|Median Total Cost, 2008 Canadian $||% of Costs Directly Attributable to RA|
|Sustained Remission (n=271)||2575||26.4|
|Sustained Low Disease Activity (n=87)||2832||25.9|
|Brief Remission (n=222)||2712||24.3|
|No Remission (n=470)||3191||25.7|
Healthcare system savings are observed in RA patients achieving remission or a low disease activity state. RA-attributable costs are constant across response categories. Ongoing observation of biologic treated patients longitudinally may identify more significant cost savings associated with a reduction in long-term severe morbidity.
To cite this abstract, please use the following information:
Barnabe, Cheryl CM, Thanh, Nguyen Xuan, Ohinmaa, Arto, Homik, Joanne, Barr, Susan G., Martin, Liam, et al; Achieving Sustained Remission in Rheumatoid Arthritis Results in Reduced Long-Term Health Care Costs. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :140