INTRODUCTION: Treat to target guidelines recommend achieving remission or low disease activity in rheumatoid arthritis (RA). However, the reduction in adverse events and costs associated with lower disease activity is unclear. METHODS: We used Corrona linked to Medicare data to identify RA patients. Time varying disease activity was measured using Clinical Disease Activity Index (CDAI); outcomes included all-cause hospitalization, a composite of hospitalization or emergency department (ED) visits, mortality, and medical costs. Outcome-specific Cox proportional models evaluated the adjusted hazard ratios between disease activity and outcomes, controlling for potential confounders including comorbidities grouped into four patient phenotypes. Costs were analyzed with mixed models using a Gaussian distribution with log transformation. RESULTS: Depending on outcome, 4593 RA patients contributed up to 12 001 person years. Median age was 71 years, 75% women. At baseline, approximately 50-60% of patients were in remission or low disease activity. There was a dose-response relationship between RA disease activity (remission, low, moderate, and high) and the incidence of hospitalizations (13.1, 17.8, 21.2, 27.5 per 100 py, respectively); all adjusted hazard ratios were significant: 0.68 (remission), 0.87 (low), and 1.24 (high) compared with moderate disease activity. Similar trends were observed for ED visits and mortality. The crude difference in annual medical costs between remission ($11 145) and moderate disease activity ($17 646) was $-6 500; the adjusted difference (95%CI) was $-3133 (-4737.72, -1528.43). CONCLUSION: Leveraging the benefits of linking registry and administrative data together, lower disease activity in RA was associated with incrementally reduced risks of all-cause hospitalization, ED visits, mortality, and medical costs in a dose-dependent fashion.
INTRODUCTION: Treat to target guidelines recommend achieving remission or low disease activity in rheumatoid arthritis (RA). However, the reduction in adverse events and costs associated with lower disease activity is unclear. METHODS: We used Corrona linked to Medicare data to identify RApatients. Time varying disease activity was measured using Clinical Disease Activity Index (CDAI); outcomes included all-cause hospitalization, a composite of hospitalization or emergency department (ED) visits, mortality, and medical costs. Outcome-specific Cox proportional models evaluated the adjusted hazard ratios between disease activity and outcomes, controlling for potential confounders including comorbidities grouped into four patient phenotypes. Costs were analyzed with mixed models using a Gaussian distribution with log transformation. RESULTS: Depending on outcome, 4593 RApatients contributed up to 12 001 person years. Median age was 71 years, 75% women. At baseline, approximately 50-60% of patients were in remission or low disease activity. There was a dose-response relationship between RA disease activity (remission, low, moderate, and high) and the incidence of hospitalizations (13.1, 17.8, 21.2, 27.5 per 100 py, respectively); all adjusted hazard ratios were significant: 0.68 (remission), 0.87 (low), and 1.24 (high) compared with moderate disease activity. Similar trends were observed for ED visits and mortality. The crude difference in annual medical costs between remission ($11 145) and moderate disease activity ($17 646) was $-6 500; the adjusted difference (95%CI) was $-3133 (-4737.72, -1528.43). CONCLUSION: Leveraging the benefits of linking registry and administrative data together, lower disease activity in RA was associated with incrementally reduced risks of all-cause hospitalization, ED visits, mortality, and medical costs in a dose-dependent fashion.
Authors: Russell V Luepker; Fred S Apple; Robert H Christenson; Richard S Crow; Stephen P Fortmann; David Goff; Robert J Goldberg; Mary M Hand; Allan S Jaffe; Desmond G Julian; Daniel Levy; Teri Manolio; Shanthi Mendis; George Mensah; Andrzej Pajak; Ronald J Prineas; K Srinath Reddy; Veronique L Roger; Wayne D Rosamond; Eyal Shahar; A Richey Sharrett; Paul Sorlie; Hugh Tunstall-Pedoe Journal: Circulation Date: 2003-11-10 Impact factor: 29.690
Authors: Jasvinder A Singh; Daniel E Furst; Aseem Bharat; Jeffrey R Curtis; Arthur F Kavanaugh; Joel M Kremer; Larry W Moreland; James O'Dell; Kevin L Winthrop; Timothy Beukelman; S Louis Bridges; W Winn Chatham; Harold E Paulus; Maria Suarez-Almazor; Claire Bombardier; Maxime Dougados; Dinesh Khanna; Charles M King; Amye L Leong; Eric L Matteson; John T Schousboe; Eileen Moynihan; Karen S Kolba; Archana Jain; Elizabeth R Volkmann; Harsh Agrawal; Sangmee Bae; Amy S Mudano; Nivedita M Patkar; Kenneth G Saag Journal: Arthritis Care Res (Hoboken) Date: 2012-05 Impact factor: 4.794
Authors: Jeffrey R Curtis; Lang Chen; Aseem Bharat; Elizabeth Delzell; Jeffrey D Greenberg; Leslie Harrold; Joel Kremer; Soko Setoguchi; Daniel H Solomon; Fenglong Xie; Huifeng Yun Journal: Arthritis Care Res (Hoboken) Date: 2014-12 Impact factor: 4.794
Authors: Jeffrey R Curtis; Ying Shan; Leslie Harrold; Jie Zhang; Jeffrey D Greenberg; George W Reed Journal: Arthritis Care Res (Hoboken) Date: 2013-10 Impact factor: 4.794
Authors: Daniel Aletaha; Valerie P K Nell; Tanja Stamm; Martin Uffmann; Stephan Pflugbeil; Klaus Machold; Josef S Smolen Journal: Arthritis Res Ther Date: 2005-04-07 Impact factor: 5.156
Authors: Josef S Smolen; Robert Landewé; Ferdinand C Breedveld; Maya Buch; Gerd Burmester; Maxime Dougados; Paul Emery; Cécile Gaujoux-Viala; Laure Gossec; Jackie Nam; Sofia Ramiro; Kevin Winthrop; Maarten de Wit; Daniel Aletaha; Neil Betteridge; Johannes W J Bijlsma; Maarten Boers; Frank Buttgereit; Bernard Combe; Maurizio Cutolo; Nemanja Damjanov; Johanna M W Hazes; Marios Kouloumas; Tore K Kvien; Xavier Mariette; Karel Pavelka; Piet L C M van Riel; Andrea Rubbert-Roth; Marieke Scholte-Voshaar; David L Scott; Tuulikki Sokka-Isler; John B Wong; Désirée van der Heijde Journal: Ann Rheum Dis Date: 2013-10-25 Impact factor: 19.103
Authors: Jeffrey R Curtis; Michael Weinblatt; Kenneth Saag; Vivian P Bykerk; Daniel E Furst; Stefano Fiore; Gregory St John; Toshio Kimura; Shen Zheng; Clifton O Bingham; Grace Wright; Martin Bergman; Kamala Nola; Christina Charles-Schoeman; Nancy Shadick Journal: Arthritis Care Res (Hoboken) Date: 2021-03-13 Impact factor: 4.794