Analysis Group Inc., Boston, MA, USA.
Pharmacoeconomics. 2012 Apr;30(4):323-36. doi: 10.2165/11589470-000000000-00000.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that often results in joint pain, inflammation and bone erosions. Perhaps the most notable change in RA treatment during the last decade is the advent of biologics, and, in particular, anti-tumour necrosis factor agents. Given these advances, it is useful to assess how healthcare and work-loss costs of patients with RA have changed.
Our objective was to assess changes in healthcare utilization and costs from 1997 to 2006 for patients diagnosed with RA.
Two cohorts (1997 and 2006) of patients with RA and matched controls were identified from two administrative claims databases along with subsamples of employed patients and matched controls. The analysis focused on the more homogeneous employee subsample. We compared annual excess co-morbidity rates, resource utilization and healthcare and work-loss costs per patient between the 1997 (n = 279) and 2006 cohorts (n = 837) with difference-in-differences methodology. Results with p < 0.05 were considered statistically significant.
In the employee subsample, there were no statistically significant differences in the excess prevalence of non-RA co-morbidities or Charlson Co-morbidity Index results, except for cardiovascular disease, which decreased by 11.1%. Excess number of ED visits and days hospitalized decreased by 1.1 visits/patient and 0.9 days/patient, respectively, while rheumatologist visits increased by 0.9 visits/patient. Excess per-patient direct costs were unchanged. However, drug costs increased by $US633/patient, but medical costs decreased by $US618/patient (not significant) [year 2006 values].
For employed patients with RA, there were significant reductions in per-patient excess hospital days, as well as ED visits, and no changes in excess total direct costs over time. New treatments introduced during the study period may be associated with cost savings that offset changes in employee utilization of drug and medical services. In addition, the reductions in excess ED visits and hospital days suggest improvements in patient quality of life.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，常导致关节疼痛、炎症和骨侵蚀。在过去十年中，RA 治疗中最显著的变化也许是生物制剂的出现，特别是抗肿瘤坏死因子制剂。鉴于这些进展，评估 RA 患者的医疗保健和工作损失成本的变化情况是很有用的。
我们的目的是评估 1997 年至 2006 年期间 RA 患者的医疗保健利用和成本变化情况。
从两个行政索赔数据库中确定了两个 RA 患者队列（1997 年和 2006 年）和匹配的对照，并为有工作的患者和匹配的对照确定了亚样本。分析重点是更同质的员工亚样本。我们使用差异法比较了 1997 年（n=279）和 2006 年（n=837）两组患者的每年过度合并症发生率、资源利用以及每位患者的医疗保健和工作损失成本。p<0.05 的结果被认为具有统计学意义。
在员工亚样本中，除了心血管疾病减少了 11.1%外，非 RA 合并症或 Charlson 合并症指数结果的过度流行率没有统计学上的显著差异。急诊就诊和住院天数的过度就诊次数分别减少了 1.1 次/患者和 0.9 天/患者，而风湿病医生就诊次数增加了 0.9 次/患者。每位患者的直接医疗费用没有变化。然而，药物成本增加了 633 美元/患者，但医疗成本减少了 618 美元/患者（无统计学意义）[2006 年的数值]。
对于患有 RA 的有工作患者，每位患者的过度住院天数以及急诊就诊次数都有显著减少，而随着时间的推移，过度的直接总成本没有变化。研究期间引入的新疗法可能与药物和医疗服务利用变化的成本节约有关。此外，过度急诊就诊和住院天数的减少表明患者生活质量的提高。
