The impact of anti‐tumour necrosis factor therapy for rheumatoid arthritis on the use of other drugs and hospital resources in a pragmatic setting

Sandhu, R. S.; Treharne, Gareth J.; Douglas, Karen; Cassim, K; Saratzis, Athanasios; Piper, H.; Erb, Nicola; Jenkins, Daniel E.; Tavakoli, Manouche; Deighton, Chris; Kitas, George D.

doi:10.1002/msc.92

Cited by 13 publications

(11 citation statements)

References 28 publications

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“…Less utilisation of physician care in the USA has previously been reported,17 and patients monitored closely in anti-TNF studies have also been reported to have less frequent visits to physicians 13. However, the explanation for these findings was traced to administration of anti-TNF therapy, and visits to physicians increased slightly for patients receiving therapy subcutaneously 13 14. In our study setting, monitoring of eventual biological treatment is integrated into the specialised outpatient care by both rheumatologists and nurses.…”

Section: Discussionmentioning

confidence: 87%

“…The decrease in the gap in healthcare utilisation between the RA cohort and referents seems largely to be explained by fewer visits by patients with RA to physicians outside the field of rheumatology, where we also saw fewer visits to physiotherapists and nurses. Less utilisation of physician care in the USA has previously been reported,17 and patients monitored closely in anti-TNF studies have also been reported to have less frequent visits to physicians 13. However, the explanation for these findings was traced to administration of anti-TNF therapy, and visits to physicians increased slightly for patients receiving therapy subcutaneously 13 14.…”

Section: Discussionmentioning

confidence: 89%

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Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population

Hagel¹,

Petersson²,

Bremander³

et al. 2013

Annals of the Rheumatic Diseases

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PurposeTo study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population.MethodsObservational cohort study. Using Swedish healthcare register data, we identified 3977 Region Skåne residents (mean age in 2001, 62.7 years; 73% women) presenting with RA (International Classification of Diseases-10 codes M05 or M06) in 1998–2001. We randomly sampled two referents from the general population per RA patient matched for age, sex and area of residence. We calculated the year 2001–2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalisations and outpatient clinic visits.ResultsBy the end of the 10-year period, 62% of patients and 74% of referents were still alive and resident in the region. From 2001 to 2010, the ratio (RA cohort/referents) of the mean number of hospitalisations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005) and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy. The absolute reduction in number of hospitalisations was from an annual mean of 0.79 to 0.69 in male patients and from 0.71 to 0.59 in female patients. The corresponding annual mean number of consultations in outpatient physician care by male and female RA patients changed from 9.2 to 7.7 and from 9.9 to 8.7, respectively.ConclusionsDuring the first decade of the 21st century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, overall inpatient and outpatient healthcare utilisation by a cohort of patients with RA decreased relative to the general population.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 89%

Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population

Hagel¹,

Petersson²,

Bremander³

et al. 2013

Annals of the Rheumatic Diseases

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“…One or more DMARDs were prescribed to over 2/3 of participants at baseline (Table 1), although during the present study no participant was on the more recently introduced biological therapies (see Sandhu et al, 2006).…”

Section: Procedures and Participantsmentioning

confidence: 99%

Predictors of fatigue over 1 year among people with rheumatoid arthritis

Treharne

Lyons

Hale

et al. 2008

Psychology, Health & Medicine

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Fatigue is a systemic feeling of exhaustion that is a common symptom of many chronic illnesses, including the autoimmune inflammatory disease rheumatoid arthritis (RA). We examined predictors of levels of fatigue among people with RA using Leventhal's Common-Sense Model (CSM), which states that cognitive representations of an illness spur (or halt) people's efforts to cope and thereby influence outcomes of the illness. Our use of the CSM was designed in the light of evidence in the literature specific to fatigue in RA. Current fatigue was reported on a 100 mm visual analogue scale (with anchors "No fatigue" and "Unbearable fatigue") by 114 people (73.7% women) with RA at baseline and 1 year later. Baseline employment status, pain, impact of disability, sleep disruption frequency, depressed mood, perceptions of consequences, arthritis self-efficacy and attempts to cope by praying/hoping were also self-reported. Duration of RA and a haematological measure of systemic inflammation (erythrocyte sedimentation rate; ESR) were obtained from hospital records. Unexpectedly, RA duration did not predict fatigue after 1 year, although lower baseline inflammation did (controlling for baseline fatigue and other disease impact variables). This may be due to sampling flares of RA at baseline. Baseline perceptions that RA has severe consequences and is uncontrollable also predicted greater fatigue after 1 year but this relationship was not mediated by praying/hoping. Targeted psychological care to modify perceptions of severe consequences may therefore improve later fatigue for people with RA even when the condition is longstanding, but the mechanisms of any benefit require further investigation.

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“…Medicines management sectors, primary care trusts or commissioners of the future will be rigorous in monitoring these therapies as financial challenges face the NHS. It is important to highlight the wider benefits of such expensive treatment resources when preparing business cases and service delivery documents -for example, the reductions in inpatient and outpatient activity (Sandhu RS et al, 2006). NICE stipulate in their guidance documents that local audits should be undertaken to demonstrate adherence to guidance.…”

Section: Data Collection and Auditmentioning

confidence: 99%

The Role of the Clinical Nurse Specialist in the Assessment and Management of Biologic Therapies

Oliver¹

2010

Musculoskeletal Care

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The impact of anti‐tumour necrosis factor therapy for rheumatoid arthritis on the use of other drugs and hospital resources in a pragmatic setting

Abstract: In a pragmatic setting, anti-TNF therapy led to reduced need for steroid injections and other DMARDs, as well as reductions in use of several hospital resources. Wider replication of these findings will be important for planning delivery.

Cited by 13 publications

References 28 publications

Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population

Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthritis cohort compared with the general population

Predictors of fatigue over 1 year among people with rheumatoid arthritis

The Role of the Clinical Nurse Specialist in the Assessment and Management of Biologic Therapies

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