Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry
Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early r...
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| Veröffentlicht in: | BMC musculoskeletal disorders 2013-12, Vol.14 (1), p.350-350, Article 350 |
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| creator | Vermeer, Marloes Kievit, Wietske Kuper, Hillechiena H Braakman-Jansen, Louise M A Bernelot Moens, Hein J Zijlstra, Theo R den Broeder, Alfons A van Riel, Piet L C M Fransen, Jaap van de Laar, Mart A F J |
| description | Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA).
We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up.
Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years.
We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving. |
| doi_str_mv | 10.1186/1471-2474-14-350 |
| format | Article |
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We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up.
Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years.
We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.</description><identifier>ISSN: 1471-2474</identifier><identifier>EISSN: 1471-2474</identifier><identifier>DOI: 10.1186/1471-2474-14-350</identifier><identifier>PMID: 24330489</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Antiarthritic agents ; Antirheumatic agents ; Antirheumatic Agents - administration & dosage ; Antirheumatic Agents - economics ; Arthritis, Rheumatoid - drug therapy ; Arthritis, Rheumatoid - economics ; Care and treatment ; Clinical medicine ; Comparative analysis ; Cost control ; Cost-Benefit Analysis ; Diagnosis ; Drug therapy ; Female ; Follow-Up Studies ; Hospitals ; Humans ; Male ; Mathematical models ; Medical economics ; Methotrexate - administration & dosage ; Methotrexate - economics ; Middle Aged ; Nonsteroidal anti-inflammatory drugs ; Nurses ; Prices and rates ; Quality of life ; Registries ; Remission Induction ; Rheumatoid arthritis ; Rheumatology ; Sulfasalazine - administration & dosage ; Sulfasalazine - economics ; Treatment Outcome ; Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><ispartof>BMC musculoskeletal disorders, 2013-12, Vol.14 (1), p.350-350, Article 350</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Vermeer et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Vermeer et al.; licensee BioMed Central Ltd. 2013 Vermeer et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b617t-a629d52ef03db7d0e0a2fdefcb073e1418cd8626bf7ce9c355f9d5ccc5b52c713</citedby><cites>FETCH-LOGICAL-b617t-a629d52ef03db7d0e0a2fdefcb073e1418cd8626bf7ce9c355f9d5ccc5b52c713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884120/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884120/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24330489$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vermeer, Marloes</creatorcontrib><creatorcontrib>Kievit, Wietske</creatorcontrib><creatorcontrib>Kuper, Hillechiena H</creatorcontrib><creatorcontrib>Braakman-Jansen, Louise M A</creatorcontrib><creatorcontrib>Bernelot Moens, Hein J</creatorcontrib><creatorcontrib>Zijlstra, Theo R</creatorcontrib><creatorcontrib>den Broeder, Alfons A</creatorcontrib><creatorcontrib>van Riel, Piet L C M</creatorcontrib><creatorcontrib>Fransen, Jaap</creatorcontrib><creatorcontrib>van de Laar, Mart A F J</creatorcontrib><title>Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry</title><title>BMC musculoskeletal disorders</title><addtitle>BMC Musculoskelet Disord</addtitle><description>Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA).
We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up.
Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years.
We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.</description><subject>Adult</subject><subject>Aged</subject><subject>Antiarthritic agents</subject><subject>Antirheumatic agents</subject><subject>Antirheumatic Agents - administration & dosage</subject><subject>Antirheumatic Agents - economics</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Arthritis, Rheumatoid - economics</subject><subject>Care and treatment</subject><subject>Clinical medicine</subject><subject>Comparative analysis</subject><subject>Cost control</subject><subject>Cost-Benefit Analysis</subject><subject>Diagnosis</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical economics</subject><subject>Methotrexate - administration & dosage</subject><subject>Methotrexate - economics</subject><subject>Middle Aged</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Nurses</subject><subject>Prices and rates</subject><subject>Quality of life</subject><subject>Registries</subject><subject>Remission Induction</subject><subject>Rheumatoid arthritis</subject><subject>Rheumatology</subject><subject>Sulfasalazine - administration & dosage</subject><subject>Sulfasalazine - economics</subject><subject>Treatment Outcome</subject><subject>Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><issn>1471-2474</issn><issn>1471-2474</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1Uk1r3DAQFSWh-WjvPQVBzk70ZcubQ2HZpEkhoVDSs5DlkVfBtlJJDuy_r8ym2yykSKBh5r3HaN4g9IWSC0rr6pIKSQsmpCioKHhJPqDjXergTXyETmJ8IoTKmi8-oiMmOCeiXhyj8BhAJzd2OHmc1oCTDh0k7C0OMLgYnR-xGzHo0G9wWMM06ORdi3VI6-CSizhf42MqwFowyb3AVabGqU9xVpk1r3_eLB9ysnMxhc0ndGh1H-Hz63uKfn27eVzdFfc_br-vlvdFU1GZCl2xRVsysIS3jWwJEM1sC9Y0RHKggtamrStWNVYaWBheljbjjTFlUzIjKT9FX7e6z1MzQGtgTEH36jm4QYeN8tqp_cro1qrzL4rXtaCMZIHVVqBx_j8C-xXjBzXPXM0zz5HKlmSV89c2gv89QUzqyU9hzD-fsRWjVAr2D9XpHpQbrc-KJhtg1LLkomLZuTqjLt5B5dNmr4wfwbqc3yOQLcEEH2MAu-ueEjWv0Hv9nr0d247wd2f4H0A0w0o</recordid><startdate>20131213</startdate><enddate>20131213</enddate><creator>Vermeer, Marloes</creator><creator>Kievit, Wietske</creator><creator>Kuper, Hillechiena H</creator><creator>Braakman-Jansen, Louise M A</creator><creator>Bernelot Moens, Hein J</creator><creator>Zijlstra, Theo R</creator><creator>den Broeder, Alfons A</creator><creator>van Riel, Piet L C M</creator><creator>Fransen, Jaap</creator><creator>van de Laar, Mart A F J</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20131213</creationdate><title>Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry</title><author>Vermeer, Marloes ; Kievit, Wietske ; Kuper, Hillechiena H ; Braakman-Jansen, Louise M A ; Bernelot Moens, Hein J ; Zijlstra, Theo R ; den Broeder, Alfons A ; van Riel, Piet L C M ; Fransen, Jaap ; van de Laar, Mart A F J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b617t-a629d52ef03db7d0e0a2fdefcb073e1418cd8626bf7ce9c355f9d5ccc5b52c713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antiarthritic agents</topic><topic>Antirheumatic agents</topic><topic>Antirheumatic Agents - administration & dosage</topic><topic>Antirheumatic Agents - economics</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Arthritis, Rheumatoid - economics</topic><topic>Care and treatment</topic><topic>Clinical medicine</topic><topic>Comparative analysis</topic><topic>Cost control</topic><topic>Cost-Benefit Analysis</topic><topic>Diagnosis</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Mathematical models</topic><topic>Medical economics</topic><topic>Methotrexate - administration & dosage</topic><topic>Methotrexate - economics</topic><topic>Middle Aged</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Nurses</topic><topic>Prices and rates</topic><topic>Quality of life</topic><topic>Registries</topic><topic>Remission Induction</topic><topic>Rheumatoid arthritis</topic><topic>Rheumatology</topic><topic>Sulfasalazine - administration & dosage</topic><topic>Sulfasalazine - economics</topic><topic>Treatment Outcome</topic><topic>Tumor Necrosis Factor-alpha - antagonists & inhibitors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vermeer, Marloes</creatorcontrib><creatorcontrib>Kievit, Wietske</creatorcontrib><creatorcontrib>Kuper, Hillechiena H</creatorcontrib><creatorcontrib>Braakman-Jansen, Louise M A</creatorcontrib><creatorcontrib>Bernelot Moens, Hein J</creatorcontrib><creatorcontrib>Zijlstra, Theo R</creatorcontrib><creatorcontrib>den Broeder, Alfons A</creatorcontrib><creatorcontrib>van Riel, Piet L C M</creatorcontrib><creatorcontrib>Fransen, Jaap</creatorcontrib><creatorcontrib>van de Laar, Mart A F J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>ProQuest - 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We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up.
Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years.
We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24330489</pmid><doi>10.1186/1471-2474-14-350</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | BMC musculoskeletal disorders, 2013-12, Vol.14 (1), p.350-350, Article 350 |
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| source | SpringerOpen; MEDLINE; Springer Journals; PubMed Central; EZB Electronic Journals Library; Directory of Open Access Journals (Open Access); PubMed Central Open Access |
| subjects | Adult Aged Antiarthritic agents Antirheumatic agents Antirheumatic Agents - administration & dosage Antirheumatic Agents - economics Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - economics Care and treatment Clinical medicine Comparative analysis Cost control Cost-Benefit Analysis Diagnosis Drug therapy Female Follow-Up Studies Hospitals Humans Male Mathematical models Medical economics Methotrexate - administration & dosage Methotrexate - economics Middle Aged Nonsteroidal anti-inflammatory drugs Nurses Prices and rates Quality of life Registries Remission Induction Rheumatoid arthritis Rheumatology Sulfasalazine - administration & dosage Sulfasalazine - economics Treatment Outcome Tumor Necrosis Factor-alpha - antagonists & inhibitors |
| title | Treating to the target of remission in early rheumatoid arthritis is cost-effective: results of the DREAM registry |
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