AB0449 Is Cost-Effective Treating to Target of Remission in Established Rheumatoid Arthritis? Results of the Create Registry
Authors: M. Cárdenas, S. de la Fuente, P. Font-Ugalde, M.C. Castro-Villegas, M. Romero-Gόmez, D. Ruiz-Vílchez, J. Calvo-Gutiérrez, R. Ortega-Castro, A. Escudero-Contreras, M.A. Casado, E. Collantes
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Treating to target (T2T) of remission has proven to be the most efficacy strategy to achieve clinical remission in patients with early rheumatoid arthritis (RA), resulting cost-effective after three years. It involves monitoring disease activity, adjusting drugs to approved protocol and aiming at a predefined target. However there is not enough clinical evidence in established and persistent RA and it has not been established the target treatment strategy. <h3>Objectives</h3> The objective was to estimate the cost-effectiveness of three strategies in real-life conditions from the Health Service perspective. T2T of remission versus achievement of low disease activity (LDA) and versus satisfactory disease control (SDC) after two years of treatment <h3>Methods</h3> All patients diagnosed of RA according to the American College of Rheumatology who started biologic therapy between January 2007 and December 2012 were included in the Create registry. A multidisciplinary care team composed by rheumatologists, hospital pharmacists, nurse and statistical personal from a tertiary hospital was the responsible for making the decision about the treatment-choice. A T2T strategy aiming at remission (DAS28&lt;2,6) was applied to all patients. This included standardised and protocolised treatment adjustment. Patients were followed up and evaluated at least every two months. <h3>Measurements</h3> Effectiveness was evaluated using the DAS28 value. Three different results were compared: Strategy 1 (S1): Clinical Remission (CR). DAS28&lt;2,6 at two years. Strategy 2 (S2): Patients at CR or at least with LDA (DAS28&lt;3,2) at two years. Strategy 3 (S3): Patients from S2 and also those patients with a DAS28&gt;3,2 at two years, but whose disease activity is judged by both the rheumatologist and patient to be low enough not to require switch of treatment (SDC). <h3>Care and cost</h3> Direct health care costs were assessed from the hospital perspective and included the official drug acquisition costs, diagnostic tests, rheumatologist visits, hospital admission and use of day-care facilities for intravenous drug administration. Data were retrieved from hospital information system and electronic case reports forms. Data of two year follow-up were analysed. <h3>Cost-effectiveness</h3> It was calculated dividing total direct healthcare mean costs by percentage of patients achieving the target clinical result for each strategy. <h3>Results</h3> 144 patients were included. After two years, 32,6% of patients achieved target for S1 (DAS28&lt;2,6), 57,6% of patients reached at least DAS28 value&lt;3,2 (S2) and 90,9% of patients reached a SDC (S3). Direct health mean cost after two years was 25,976.05 € (IC95%:23,888.16-28,063.93). T2T of remission was the least cost-effective strategy: 79,681.14€ per clinical remission (SD ±38,880.43€), versus 45,097€/LDA (±22,00.,24€) and 28,545.11€/SDC (±13,958.59€), (p&lt;0,001 in both cases S1 vs S2 and S1 vs S3). Similarly, S2 was less cost-effective than S3 (p&lt;0,001). <h3>Conclusions</h3> T2T of remission strategy with biologic therapy in established RA and in real-life conditions is less cost-effective than T2T of low disease activity or satisfactory disease control. <h3>Disclosure of Interest</h3> None declared