Article Text


SAT0256 Economic impact of infliximab treatment in rheumatoid arthritis; correlation with disease activity score
  1. A Kavanaugh1,
  2. K Patel2,
  3. M Bala2,
  4. L Noe3,
  5. C Antoni4
  1. 1Rheumatology, University of California at San Diego, La Jolla, USA
  2. 2Biostatistics, Centocor, Inc., Malvern
  3. 3Ovation Research Group, Highland Park, USA
  4. 4Medicine, University Erlangen-Nuremberg, Erlangen, Germany


Background In the ATTRACT trial, rheumatoid arthritis (RA) patients treated with the anti-TNF monoclonal antibody infliximab showed significant improvement in the signs and symptoms of disease (e.g. as measured with using the Disease Activity Score [DAS]); treatment also achieved improvement in quality of life measures and inhibited the progression of structural damage at 54 weeks. The ultimate clinical utility of biologic agents may be impacted by their high acquisition costs. However, RA is itself associated with substantial direct and indirect costs that vary with the severity of disease. Therefore, highly effective therapies for RA may be cost effective.

Objectives To assess the total costs of treating RA, exclusive of the costs of study medication, for patients enrolled in the ATTRACT trial, and to correlate total costs with disease activity and response to therapy using the DAS.

Methods Economic evaluation was performed on patients in the ATTRACT trial over 54 weeks of study. The economic impact of improvement in disease activity was assessed by analysing costs according to clinical response using the DAS. DAS28 was calculated as follows:

0.56*SQRT(TJC) + 0.28*SQRT(SJC) +0.7ln (ESR) + 0.014*(pt global (VAS)).

Clinical responses in the trial were characterised as ‘None’, ‘Moderate’ or ‘Good’ using DAS scores at endpoint and change in DAS during the study. Categorical variables were tested using Cochran-Mantel-Haenszel test.

Results Clinical efficacy at 54 weeks was significantly greater among patients receiving infliximab compared to those receiving placebo (p = 0.001). Total cost among all patients with ?Good? DAS response was $3,836 compared to $5,613 and $13,125 among patients with ?Moderate? and ?None? response respectively. Thus, patients who had a ?Good? DAS response cost $9,289 less on average, compared to ?None? DAS response. DAS28 response rates and total cost by DAS response are presented below.

Abstract SAT0256 Table 1

Conclusion Improvement in DAS significantly reduced the cost of treating RA patients. In patients with severe RA, therapy with infliximab was effective, as assessed by DAS. Moreover, patients achieving moderate and good DAS responses incurred significantly less costs over 54 weeks of therapy than non-responders. This data shows that among patients with severe RA, highly effective therapy, such as infliximab, can reduce costs. Such therapy may be cost effective.

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