Pharmacoeconomic study of patients with chronic inflammatory joint disease before and during infliximab treatment

Abstract

Objective: To evaluate medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment in routine clinical practice. Methods: Starting from 1999, clinical and laboratory variables for patients treated with biological agents for inflammatory rheumatic diseases were systematically recorded at Helsinki University Central Hospital. From this database clinical information was collected on 96 patients in whom infliximab was started during the period 1999 to 2001. Economic analyses were based on costs incurred because of outpatient and inpatient visits, orthopaedic operations, drugs used, and days on sickness or rehabilitation allowance. Medical and work disability costs were calculated separately for the one year period before (period I) and the one year period after institution of infliximab (period II). Results: Of the study group of 96 patients (arthritis duration 16 years (range 3 to 43)), 74 completed one year of infliximab treatment. Their clinical and laboratory variables improved significantly. The mean increase in medical costs during period II was J12 015 (95% confidence interval, 6496 to 18 076). A minimal decrease in work disability costs occurred-mean decrease J130 (21268 to 1072). Conclusions: One year treatment with infliximab in patients with longstanding aggressive arthritis showed a good clinical effect but raised medical costs significantly. Work disability costs failed to show a substantial decrease. Starting infliximab in the earlier stages of chronic arthritis could in the long term prevent work disability and thus decrease the total cost to society.

Patients with rheumatoid arthritis treated with tumour necrosis factor antagonists increase their participation in the workforce: potential for significant long-term indirect cost gains (data from a population-based registry)

“…Yelin et al found significant improvements in hours worked/week over 1 year in patients treated with etanercept compared to untreated patients and Allaire et al found a significant benefit in the subgroup with a disease duration <11 years 8 10. The results do, however, conflict with the findings of Mittendorf et al , who could not detect any improvements in hours worked/week over 3 years of follow-up, although ability to work did not deteriorate either, and Laas et al who found no substantial decrease in work disability costs during the first year of treatment with infliximab 9 11. The sources of these discrepancies may be different length of follow-up, differences in disease severity in the samples investigated, and differences in the labour market in the respective countries.…”

“…Yelin et al found significant improvements in hours worked/week over 1 year in patients treated with etanercept compared to untreated patients 8. In contrast, no substantial decrease in cost was found in a recent observational study comparing work disability costs during the first year of treatment with infliximab to the costs incurred during the year before start of treatment 9. More recently employment loss was found not to differ between American patients with RA treated with TNF antagonists compared to matched controls, although a significant benefit was found in the subgroup with a disease duration <11 years 10.…”

Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study

“…The introduction of tumour necrosis factor (TNF) antagonists has played a major role with better control of symptoms, halting of radiological progression and improvement of functional capacity and health related quality of life 9–14. Reports on the effect of anti-TNF treatment on work disability have, however, been conflicting depending on the setting and study design 15–21…”

Effect of TNF antagonists on the productivity of daily work of patients with rheumatoid arthritis

“…Although biologics often induce rapid clinical improvements in patients with RA, the price of these drugs limits their use. 11,12 Thus, estimating the direct and indirect effects of biological agents, such as clinical outcomes, is important.…”