title: Evolution of direct costs in the first years of rheumatoid arthritis: impact of early versus late biologic initiation--an economic analysis based on the ESPOIR cohort.
abstract: OBJECTIVE
  To estimate annual direct costs of early RA by resource component in an inception cohort, with reference to four distinct treatment strategies: no disease modifying antirheumatic drugs (DMARDs), synthetic DMARDs only, biologic DMARDs in the first year ('first-year biologic', FYB), and biologic DMARDs from the second year after inclusion ('later-year biologic', LYB); to determine predictors of total and non-DMARD related costs.
  
  
  METHODS
  The ESPOIR cohort is a French multicentric, prospective study of 813 patients with early arthritis. Data assessing RA-related resource utilisation and disease characteristics were collected at baseline, biannually during the first two years and annually thereafter. Costs predictors were determined by generalised linear mixed analyses.
  
  
  RESULTS
  Over the 4-year follow-up, mean annual direct total costs per treatment strategy group were €3,612 for all patients and €998, €1,922, €14,791, €8,477 respectively for no DMARDs, synthetic DMARDs only, FYB and LYB users. The main predictors of higher costs were biologic use and higher Health Assessment Questionnaire (HAQ) scores at baseline. Being a biologic user led to a higher total cost (FYB Rate Ratio (RR) 7.22, [95% CI 5.59-9.31]; LYB RR 4.39, [95% CI 3.58-5.39]) compared to non-biologic users. Only LYB increased non-DMARD related costs compared to all other patients by 60%.
  
  
  CONCLUSIONS
  FYB users incurred the highest levels of total costs, while their non-DMARD related costs remained similar to non-biologic users, possibly reflecting better RA control.
authors.affiliation: URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France; Inserm, ECEVE, U1123, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.affiliation: URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Haour
authors.affiliation: URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France.
authors.forename: Sandy
authors.initials: S
authors.lastname: Lucier
authors.affiliation: URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France; Pierre and Marie Curie University (UPMC) - Paris 6, UPMC GRC 08, Institut Pierre Louis d'Epidémiologie et Santé Publique, Paris, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Harvard
authors.affiliation: Pharmacology and Toxicology Unit, Centre of Pharmacovigilance-Pharmacoepidemiology CHU, Limoges, France; Limoges University, EA 6310 HAVAE, Faculty of Medicine, Limoges, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Laroche
authors.affiliation: Paris XI University, Department of Rheumatology, Bicêtre University Hospital (AP-HP), Le Kremlin Bicêtre, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.affiliation: Brest University, Department of Rheumatology, La Cavale Blanche Hospital, Brest, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: URC Eco Île-de-France (AP-HP), Hôtel Dieu, Paris, France; Inserm, ECEVE, U1123, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, Paris, France; Department of Public Health, Henri Mondor-Albert Chenevilier Hospitals (AP-HP), Créteil, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
authors.affiliation: Lorraine University, EA 4360 APEMAC; INSERM CIC-EC CIE6, Nancy, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.affiliation: Pierre and Marie Curie University (UPMC) - Paris 6, UPMC GRC 08, Institut Pierre Louis d'Epidémiologie et Santé Publique, Paris, France; AP-HP, Department of Rheumatology, La Pitié Salpêtrière University Hospital, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
mesh_terms: D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000628:therapy*; D001691:Biological Therapy / Q000191:economics*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013997:Time Factors