University of Nebraska Medical Center, Omaha, NE, National Data Bank for Rheumatic Diseases, Wichita, KS.
Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA.
Rheumatology (Oxford). 2015 Sep;54(9):1640-9. doi: 10.1093/rheumatology/kev023. Epub 2015 Apr 15.
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.
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.
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.
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.
多生物标志物疾病活动（MBDA）血液检测已在临床上验证为评估类风湿关节炎（RA）患者疾病活动的指标。我们旨在评估 MBDA 测试对 RA 患者的身体功能（基于 HAQ）、质量调整生命年和 10 年内成本的影响。
进行决策分析以量化使用 MBDA 测试对私人支付者和雇主的 RA 相关结果和成本的影响。一项报告使用 MBDA 测试后改变抗风湿药物建议的临床管理研究的结果为临床效用提供了信息。治疗变化对 HAQ 的影响来自 5 项严格控制和 13 项治疗转换试验。基线 HAQ 评分以及 HAQ 评分与医疗成本和生活质量的关系来自已发表的国家风湿病数据银行数据。
预计在第 1 年使用 MBDA 测试将使 HAQ 评分提高 0.09 个单位，在 10 年后降至 0.02 个单位。在 10 年的时间内，质量调整生命年增加了 0.08 年，成本降低了 457 美元（残疾相关医疗费用的节省为 659 美元；在生产力成本方面，节省了 2137 美元）。分析中最具影响力的变量是 MBDA 测试对临床医生治疗建议的影响及其对 HAQ 变化的后续影响。
MBDA 测试通过改变治疗决策、改善患者的功能状态和节省成本，帮助评估 RA 患者的疾病活动。进一步的验证正在进行中，未来需要进行纵向研究。
