Background Loss of work productivity has been the most expensive consequence of rheumatoid arthritis but more effective drug treatments have in recent years resulted in savings in productivity costs.
Objectives In this study we estimated the capacity of the induction treatment with infliximab added on an already intensive combination treatment with conventional antirheumatic drugs to result in further savings in costs of absenteeism (ABS) and presenteeism (PRES).
Methods 99 patients with active early RA were enrolled into an investigator-initiated, randomized, double-blind, trial, the NEO-RACo trial. They were treated with an intensified combination (FR) of MTX, SASP, HCQ, low-dose prednisolone, and intra-articular glucocorticoid (GC) injections for 2 years. In addition, they were randomized to receive an added-on induction treatment with either infliximab (FR+INFL group) or placebo (FR+Pla group) infusions for the initial 6 months. Patients were assessed clinically 11 times during the first 12 months and thereafter every 3 months. At all times, treatment was targeted to a modified strict ACR remission with increase of drug doses or switch between DMARDs, as well as GC injections into swollen joints, if RA was active. Data about RA-related lost workdays (ABS) were gathered, as well as about self-reported PRES with VAS. The monetary value of lost productivity was estimated by the human capital method based on the mean earnings of all employees obtained from Statistics Finland and added by supplementary social welfare expenses: men 4656 EUR and women 3868 EUR per month, respectively.
Results Table 1 shows the amount of estimated work productivity loss by PRES and ABS during the follow-up.
The total loss of productivity per patient amounted in the 1st year 15 669 EUR and in the 2nd 7 011 EUR in FR+Pla. In FR+INFL, the respective sums were 10 225 and 4 791 EUR. The ratio of lost productivity between groups was 1.54 (95% CI: 1.02 to 2.21) in the 1st year and 1.52 (0.51 to 3.03 in the 2nd year; adjusted for age, sex, rheumatoid factor, duration of symptoms, as well as baseline DAS28 and physician's global assessment (PhGA). The ratio between ABS and PRES was 2.56 (95% CI: 1.53 to 3.59) in the 1st and 6.46 (1.74 to 11.17) in the 2nd year. The baseline variables (sex, age, DAS28, rheumatoid factor, duration of symptoms, PhGA, symptoms of depression, vitality, and BMI) were tested as predictors of the 1st year ABS and PRES. PhGA, vitality, and BMI entered into the forward stepwise regression model for PRES. Regarding ABS only PhGA entered into the model.
Conclusions Despite an intensive treatment with three conventional DMARDs, low-dose prednisolone, and intra-articular GC injections an added-on 6-month induction treatment with INFL resulted in savings in costs of ABS during the 1st treatment year but not later. Significant influence on PRES was not shown.
Disclosure of Interest None declared