Background Little is known about the cost trajectory in patients starting biologics with moderate disease activity.
Objectives To compare 1-year health care costs and productivity losses after initiation of first biologic treatment in RA-patients with high vs moderate disease activity at treatment start.
Methods In the Swedish Biologics Register (ARTIS), we identified patients with RA starting their first biologic in 2007-2009 who had baseline DAS28 recorded (n=2143; 138 low [DAS28 <3.2], 898 moderate [DAS28 3.2-5.0], and 1107 high disease activity [DAS28 ≥5.1]). Data on inpatient and nonprimary outpatient care, prescription drugs, and productivity losses were retrieved from nationwide registers. Mean cost differences (expressed in 2010 €) with 95%CIs were estimated using nonparametric bootstrapping, adjusting for age, sex, and costs during the previous year.
Results Patients with high baseline disease activity were older than those with moderate disease activity (59 vs 56y; P<.001), but did not differ regarding sex (75% vs 75% women; P=.99) or disease duration (10 vs 9y; P=.14). 64% of patients with high and 75% with moderate disease activity were of working age (18-64y; P<.001). During the year after initiation of biologics, patients starting with high and moderate disease activity accumulated health care costs of €17,993 and €16,488, respectively (adj. difference €965, 95%CI 2-1951). In working age patients, high (vs moderate) baseline disease activity was associated with greater productivity losses (€23,837 vs €18,394; adj. difference €1550, 95%CI 538-2562). For patients starting biologics with high compared to moderate disease activity the total 1-year costs were €41,089 vs €34,416 (Figure; adj. difference €2079, 95%CI 586-3572).
Conclusions Patients initiating biologic treatment with high compared to moderate baseline disease activity accumulated more costs over 1 year. After adjustment, the costs were higher for inpatient care and productivity losses, but not for nonprimary outpatient care or drugs.
Acknowledgements The study was partly funded by Pfizer.
Disclosure of Interest None Declared
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