title: Healthcare service utilisation costs are reduced when rheumatoid arthritis patients achieve sustained remission.
abstract: OBJECTIVE
  Determine healthcare service utilisation costs among patients using biological therapies for rheumatoid arthritis (RA), considering the magnitude and duration of patient response achieved.
  
  
  METHODS
  Clinical data from the Alberta Biologics Pharmacosurveillance Program (ABioPharm) was linked with provincial physician billing claims, outpatient visits and hospitalisations. The annual mean healthcare service utilisation costs (total, RA-attributable, non-RA attributable) were estimated for patients during the best disease activity level reached during treatment.
  
  
  RESULTS
  Of 1086 patients: 16% achieved DAS28 remission >1 year, 37% had a DAS28 remission period <1 year, 13% had a low disease activity (LDA) period <1 year and 31% had persistent moderate or high disease activity. Mean annual healthcare service utilisation cost savings for those in sustained remission was $2391 (95% CI 1437 to 3909, p<0.001) and $2104 (95% CI 838 to 3512, p<0.001) for those with non-sustained LDA, relative to the persistent disease activity group. Savings were also observed for those in sustained remission compared to non-sustained remission (annual savings $1422, 95% CI 564 to 2796, p<0.001). RA-related costs were consistent across disease activity and cost categories; the majority of costs were attributable to non-RA related hospitalisations.
  
  
  CONCLUSIONS
  We provide evidence of economic benefits to the healthcare system when RA patients achieve persistent good disease control. Benefits from brief periods of remission and LDA are also observed. Coupled with an expected increase in productivity from improved disease control, there is societal benefit to the utilisation of biologics in RA management to achieve treatment goals.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada. ccbarnab@ucalgary.ca
authors.forename: Cheryl
authors.initials: C
authors.lastname: Barnabe
authors.forename: Nguyen Xuan
authors.initials: NX
authors.lastname: Thanh
authors.forename: Arto
authors.initials: A
authors.lastname: Ohinmaa
authors.forename: Joanne
authors.initials: J
authors.lastname: Homik
authors.forename: Susan G
authors.initials: SG
authors.lastname: Barr
authors.forename: Liam
authors.initials: L
authors.lastname: Martin
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D001688:Biological Products / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012074:Remission Induction; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: Disease Activity; Economic Evaluations; Health services research; Rheumatoid Arthritis; Treatment