Cheryl Barnabe1, Nguyen Xuan Thanh2, Arto Ohinmaa2, Joanne Homik2, Susan G Barr2, Liam Martin2, Walter P Maksymowych2. 1. From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta. ccbarnab@ucalgary.ca. 2. From the Department of Medicine, University of Calgary, Calgary; Department of Community Health Sciences, University of Calgary, Calgary; Institute of Health Economics, Edmonton; School of Public Health, University of Alberta, Edmonton; and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.C. Barnabe, MD, MSc, FRCPC, Department of Medicine and Department of Community Health Sciences, University of Calgary; N.X. Thanh, MD, PhD, MPH, Institute of Health Economics and School of Public Health, University of Alberta; A. Ohinmaa, PhD, Institute of Health Economics and School of Public Health, University of Alberta; J. Homik, MD, MSc, FRCPC, Department of Medicine, University of Alberta; S.G. Barr, MD, MSc, FRCPC, Department of Medicine, and Department of Community Health Sciences, University of Calgary; L. Martin, MB, ChB, FRCPC, Department of Medicine, University of Calgary; W.P. Maksymowych, MB, ChB, FRCPC, Department of Medicine, University of Alberta.
Abstract
OBJECTIVE: Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. METHODS: The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. RESULTS: In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. CONCLUSION: The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.
OBJECTIVE: Sustained remission in rheumatoid arthritis (RA) results in healthcare utilization cost savings. We evaluated the variation in estimates of savings when different definitions of remission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index (CDAI) ≤ 2.8, and Disease Activity Score-28 (DAS28) ≤ 2.6] are applied. METHODS: The annual mean healthcare service utilization costs were estimated from provincial physician billing claims, outpatient visits, and hospitalizations, with linkage to clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm). Cost savings in patients who had a 1-year continuous period of remission were compared to those who did not, using 4 definitions of remission. RESULTS: In 1086 patients, sustained remission rates were 16.1% for DAS28, 8.8% for Boolean, 5.5% for CDAI, and 4.2% for SDAI. The estimated mean annual healthcare cost savings per patient achieving remission (relative to not) were SDAI $1928 (95% CI 592, 3264), DAS28 $1676 (95% CI 987, 2365), and Boolean $1259 (95% CI 417, 2100). The annual savings by CDAI remission per patient were not significant at $423 (95% CI -1757, 2602). For patients in DAS28, Boolean, and SDAI remission, savings were seen both in costs directly related to RA and its comorbidities, and in costs for non-RA-related conditions. CONCLUSION: The magnitude of the healthcare cost savings varies according to the remission definition used in classifying patient disease status. The highest point estimate for cost savings was observed in patients attaining SDAI remission and the least with the CDAI; confidence intervals for these estimates do overlap. Future pharmacoeconomic analyses should employ all response definitions in assessing the influence of treatment.
Authors: Bruce C M Wang; Ping-Ning Hsu; Wesley Furnback; John Ney; Ya-Wen Yang; Chi-Hui Fang; Chao-Hsiun Tang Journal: Drugs Real World Outcomes Date: 2016-03