Rheumatoid arthritis is already expensive during the first year of the disease (the Swedish TIRA project)

Hallert, Eva; Husberg, Magnus; Jonsson, Dick; Skogh, Thomas

doi:10.1093/rheumatology/keh324

Cited by 54 publications

(60 citation statements)

References 30 publications

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“…Comparisons with other studies of early arthritis performed in the 2000s is difficult because the recall period is often shorter and some countries quantify only sick leaves longer than 14 days, but our results seem to be lower than in other publications. Bjork et al found 33% of patients with sick leave Ͼ14 days in the previous 3 months at year 1 and Hallert et al found 62% of patients with any sick leave in the previous 6 months ( 14,39,40). Nevertheless, 11.2% of patients from our study declared permanent disability by the end of the third year, and this result is consistent with a 2006 French report indicating that the proportion of RA patients in France receiving disability compensations reached 10.7% after 3 years of disease (35).…”

Section: Discussionmentioning

confidence: 99%

“…The first years of disease were found to be particularly important in establishing permanent disability and high disability costs (13)(14)(15).apy with new biologic agents and treatment strategies on WP in RA patients, reporting a decrease in WP loss, but most of these studies were controlled trials over short periods and often enrolled patients with established RA (16 -23). Indeed, we lack longitudinal studies evaluating the effect of biologic agents on WP and its costs in early arthritis.…”

Section: Introductionmentioning

confidence: 99%

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Work Productivity Loss in Early Arthritis During the First 3 Years of Disease: A Study From a French National Multicenter Cohort

Dadoun

Guillemin

Lucier³

et al. 2014

Arthritis Care & Research

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Objective. To assess work productivity (WP) loss during the first 3 years of disease in a cohort of patients with early arthritis (EA) diagnosed between 2002 and 2005. Methods. The ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) cohort included 813 EA patients; we included those of working age at baseline in the present study. WP loss was assessed by 3 components: sick leave, permanent disability, and early retirement. The proportion of affected patients and the mean number of days off work were assessed for each component. WP costs were estimated and determinants of positive and extreme costs were assessed by logistic regression models. Results. Among the 664 patients included, 81.6% were in the workforce at baseline. During the first 3 years of disease, 45% reported at least 1 sick leave day and 11% reported permanent disability. Only a few patients (1%) reported early retirement. The mean number of days on sick leave due to EA decreased regularly from 44 to 13, whereas the mean number of days on permanent disability tripled from 10 to 33. The mean annual cost was €1,333 (95% confidence interval €1,075-1,620). Sick leave longer than 30 days due to EA before inclusion and a decrease in mental and physical scores of the Medical Outcomes Study Short Form 36 at inclusion were independent determinants of positive and extreme costs in multivariate models. Conclusion. WP loss is substantial in EA patients and is due to permanent disability before the third year of disease. Work absence and poor mental and physical health status at baseline are major determinants of WP costs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Work Productivity Loss in Early Arthritis During the First 3 Years of Disease: A Study From a French National Multicenter Cohort

Dadoun

Guillemin

Lucier³

et al. 2014

Arthritis Care & Research

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“…The results demonstrate a benefit beyond clinical improvement. A reduction in work disability in early RA can have substantial health economics implications; the indirect costs of RA are particularly high in the first year of disease (21), probably owing to the fact that remission/ mild disease state with conventional DMARDs is not immediate. Earlier disease control correlates with less work disability, as demonstrated in this study, and therefore indirect costs are likely to improve with its use.…”

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confidence: 99%

Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

Bejarano

Quinn

Conaghan

et al. 2008

Arthritis & Rheumatism

157

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Objective. To compare work disability and job loss in early rheumatoid arthritis (RA) patients receiving adalimumab plus methotrexate (adalimumab ؉ MTX) versus MTX alone. Methods. In this multicenter, randomized, controlled trial, patients with RA for <2 years who had never taken MTX and who self-reported work impairment were randomized to adalimumab ؉ MTX or placebo ؉ MTX for 56 weeks. Primary outcome was job loss of any cause and/or imminent job loss at or after week 16. Secondary outcomes included disease activity, function (Health Assessment Questionnaire [HAQ] score), and RA quality of life (RAQoL) questionnaire score. Work was evaluated with work diaries and the RA Work Instability Scale. Results. Although job loss during the 56-week study was significantly lower with adalimumab ؉ MTX (14 of 75 patients) compared with MTX alone (29 of 73 patients; P ‫؍‬ 0.005), the primary end point was not met (12 of 75 versus 20 of 73 patients; P ‫؍‬ 0.092), likely owing to early drop out in the MTX group. There were significant improvements in American College of Rheumatology 20% response criteria, 28-joint Disease Activity Score, ⌬HAQ, ⌬RAQoL, and working time lost in the adalimumab ؉ MTX group. Twenty-four serious adverse events were reported in 17 participants, with no differences between groups. Conclusion. Adalimumab ؉ MTX reduced job loss and improved productivity in early RA when compared with MTX alone, which supports the early use of anti-tumor necrosis factor therapy and suggests its cost efficacy.

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“…Although costs caused by healthcare utilization are high, the total costs are mainly driven by loss of working capacity (2)(3)(4)(5). Major advances regarding aetiopathogenis, diagnostics, disease classification, pharmacotherapy and structured follow-up of patients with RA have radically changed clinical routines regarding treatment of RA (6).…”

Section: Introductionmentioning

confidence: 99%

“…However, results from longitudinal observational studies imply that the positive effects of biologic anti-rheumatic drugs are less pronounced in real life, compared to those reported in clinical trials, hence giving higher costs per qualityadjusted life year, compared to estimates from clinical trials (10). Based on the Swedish TIRA project (acronym for early intervention in RA), we have previously reported that direct and indirect costs were very high during the first years following diagnosis of early RA (3,12). The present study was done during a period when biologic drugs were introduced in Swedish clinical routine and the aim was to calculate direct and indirect costs in patients with early RA in Sweden during the 6-year period following diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project

Hallert

Husberg

Kalkan

et al. 2013

Scandinavian Journal of Rheumatology

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Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity (the Swedish TIRA project). Eva AbstractObjectives. To calculate total costs during 6 years after diagnosis of early rheumatoid arthritis.Methods. In the longitudinal prospective multicenter TIRA study, 239 patients from 7 units, diagnosed 1996-98, reported regularly health care utilization and number of days lost from work. Costs were obtained from official databases and calculated using unit costs (Swedish kronor, SEK) from 2001. Indirect costs were calculated using human capital approach. Costs were inflation-adjusted to Euro June 2012, using Swedish Consumer Price Index and exchange rate June 2012. Statistical analyses were based on linear mixed models (LMM) for changes over time.Results. Mean total cost/patient was €14768 in year 1 and increased to €18438 in year 6. Outpatient visits and hospitalization decreased, but costs for surgery increased from €92/patient year 1 to €444 year 6. Drugs increased from €429/patient to €2214/patient, mainly due to introduction of biologics. Year 1, drugs made up for 10% of direct costs and increased to 49% in year 6. Sick leave decreased during the first years, but disability pensions increased, resulting in unchanged indirect costs. Over the following years, disability pensions increased further and indirect costs increased from €10284 year 1 to €13874 year 6. LMM analyses showed that indirect costs were unchanged while direct costs, after an initial drop, increased over the following years, leading to increasing total costs.Conclusions. Drug costs were partially offset by decreasing outpatient visits but indirect costs remained unchanged and total costs increased.

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Rheumatoid arthritis is already expensive during the first year of the disease (the Swedish TIRA project)

Cited by 54 publications

References 30 publications

Work Productivity Loss in Early Arthritis During the First 3 Years of Disease: A Study From a French National Multicenter Cohort

Work Productivity Loss in Early Arthritis During the First 3 Years of Disease: A Study From a French National Multicenter Cohort

Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project

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