title: Outcomes and costs of incorporating a multibiomarker disease activity test in the management of patients with rheumatoid arthritis.
abstract: OBJECTIVE
  The multibiomarker disease activity (MBDA) blood test has been clinically validated as a measure of disease activity in patients with RA. We aimed to estimate the effect of the MBDA test on physical function for patients with RA (based on HAQ), quality-adjusted life years and costs over 10 years.
  
  
  METHODS
  A decision analysis was conducted to quantify the effect of using the MBDA test on RA-related outcomes and costs to private payers and employers. Results of a clinical management study reporting changes to anti-rheumatic drug recommendations after use of the MBDA test informed clinical utility. The effect of treatment changes on HAQ was derived from 5 tight-control and 13 treatment-switch trials. Baseline HAQ scores and the HAQ score relationship with medical costs and quality of life were derived from published National Data Bank for Rheumatic Diseases data.
  
  
  RESULTS
  Use of the MBDA test is projected to improve HAQ scores by 0.09 units in year 1, declining to 0.02 units after 10 years. Over the 10 year time horizon, quality-adjusted life years increased by 0.08 years and costs decreased by US$457 (cost savings in disability-related medical costs, US$659; in productivity costs, US$2137). The most influential variable in the analysis was the effect of the MBDA test on clinician treatment recommendations and subsequent HAQ changes.
  
  
  CONCLUSIONS
  The MBDA test aids in the assessment of disease activity in patients with RA by changing treatment decisions, improving the functional status of patients and cost savings. Further validation is ongoing and future longitudinal studies are warranted.
authors: University of Nebraska Medical Center, Omaha, NE, National Data Bank for Rheumatic Diseases, Wichita, KS.
authors: Kaleb
authors: K
authors: Michaud
authors: Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA.
authors: Vibeke
authors: V
authors: Strand
authors: Brigham & Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA.
authors: Nancy A
authors: NA
authors: Shadick
authors: Cedar Associates, Menlo Park, CA.
authors: Irina
authors: I
authors: Degtiar
authors: Crescendo Bioscience, San Francisco, CA, USA and.
authors: Kerri
authors: K
authors: Ford
authors: Cedar Associates, Menlo Park, CA.
authors: Steven N
authors: SN
authors: Michalopoulos
authors: Cedar Associates, Menlo Park, CA, Department of Internal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA ujch@stanford.edu.
authors: John
authors: J
authors: Hornberger
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004185:Disability Evaluation; D019468:Disease Management; D017048:Health Care Costs; D006403:Hematologic Tests / Q000191:economics* / Q000379:methods*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers
keywords: biomarkers; health economics; outcome assessment; quality of life; rheumatoid arthritis