Objective: To evaluate medical and work disability costs for patients with chronic inflammatory joint disease during one year before and one year after institution of infliximab treatment in routine clinical practice.
Methods: Starting from 1999, clinical and laboratory variables for patients treated with biological agents for inflammatory rheumatic diseases were systematically recorded at Helsinki University Central Hospital. From this database clinical information was collected on 96 patients in whom infliximab was started during the period 1999 to 2001. Economic analyses were based on costs incurred because of outpatient and inpatient visits, orthopaedic operations, drugs used, and days on sickness or rehabilitation allowance. Medical and work disability costs were calculated separately for the one year period before (period I) and the one year period after institution of infliximab (period II).
Results: Of the study group of 96 patients (arthritis duration 16 years (range 3 to 43)), 74 completed one year of infliximab treatment. Their clinical and laboratory variables improved significantly. The mean increase in medical costs during period II was €12 015 (95% confidence interval, 6496 to 18 076). A minimal decrease in work disability costs occurred—mean decrease €130 (−1268 to 1072).
Conclusions: One year treatment with infliximab in patients with longstanding aggressive arthritis showed a good clinical effect but raised medical costs significantly. Work disability costs failed to show a substantial decrease. Starting infliximab in the earlier stages of chronic arthritis could in the long term prevent work disability and thus decrease the total cost to society.
- ACR, American College of Rheumatology
- ATTRACT, Anti-Tumor necrosis factor Trial in Rheumatoid Arthritis with Concomitant Therapy
- DMARD, disease modifying antirheumatic drug
- HAQ, health assessment questionnaire
- IQR, interquartile range
- NSAID, non-steroidal anti-inflammatory drug
- QALY, quality adjusted life year
- VAS, visual analogue scale
- rheumatoid arthritis
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