AB0241 DISEASE COURSE AND COSTS OF A COHORT OF RHEUMATOID ARTHRITIS PATIENTS OVER A PERIOD OF 6 YEARS
Authors: Gizem Ayan, Sinem Nihal Esatoglu, Gulen Hatemi, Vedat Hamuryudan
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> A previous multicenter, cross-sectional study showed a substantial economic burden of rheumatoid arthritis (RA) in Turkey with significant positive correlation between disease severity and total costs (1). <h3>Objectives</h3> To calculate the annual costs and to assess disease activity and functional outcome of RA patients from a single center over a period of 6 years. <h3>Methods</h3> The previous study on healthcare costs in RA was performed in the outpatient clinics of 10 university hospitals between May 2011 and August 2012 (1). A total of 689 RA patients (all fulfilling ACR 1987 criteria) were studied of whom 75 (11%) being from our center. In March 2018, we called back our patients to the clinic for re-evaluation by using the questionnaire of the previous study containing questions on demographics, medication use and RA-related direct and indirect costs. We assessed disease activity with the Routine assessment of Patient Index Data 3 (RAPID3), functional status with HAQ-DI and Steinbrocker functional index and quality of life (QoL) with EuroQol Quality of Life Scale (EQ-5D). <h3>Results</h3> We could interview 62 patients (83%) in the clinic. Of the remaining 13 patients, 7(9%) had died, 3 were receiving palliative care following cardio-vascular events, 2 went to other centers and 1 declined to participate. The mean age and mean disease duration of the 62 re-evaluated patients (52 women, 10 men) were 56.8±13.3 SD years and 225±120 SD months, respectively. Forty-nine (79%) had used at least 1 biologic agent during follow-up and 34 (55%) were still on biologics at the time of re-evaluation. Disease activity was lower but was not significantly different from that of the previous study. However, functional status and QoL had improved significantly over time (Table 1). The majority of the patients (89%) were in Steinbrocker Class 1 or 2 with only 7 (11%) being in Steinbrocker Class 3. Of the 7 deceased patients (4 women 3 men; mean age: 68.2±8.12 SD years; mean disease duration: 127.6±73.8 SD months) 3 were on Rituximab, 2 were on synthetic DMARD's (one being biologic naïve) and 2 were free of RA medications (one was biologic naïve) at the time of death. Serious infections were the cause of death in 4 patients followed by hepatic failure due to hepatitis B, abdominal bleeding under anticoagulation and multi organ failure in 3 patients, respectively. Direct costs were higher than indirect costs and made up two thirds of RA related total costs (Table 1). <h3>Conclusion</h3> Disease activity remained stable and functional status and QoL improved among our patients over 6 years. Biologic usage was increased. Cardiovascular events and serious infections were major determinants of morbidity and mortality. Direct costs were the main determinants of RA related cost. <h3>Results</h3> The survey was replied by 41 rheumatologists, representing all regions in the country. Table 1 shows a summary of the results of the second round in terms of m and SD. To summarize, there was an agreement regarding the drugs that might be more adequate for patients with particular prognostic factors, except in the case of pulmonary involvement, in which agreement was only met for T-cell co-stimulation, and for elevated HAQ and acute phase reactants, where the use of B-cell depressant treatments did not reach an 80% of agreement. <h3>Reference</h3> [1] Hamuryudan V, et al. Clin Exp Rheumatol2016; 34: 1033 <h3> Acknowledgement</h3> Supported with an unrestricted grant from Pfizer <h3>Disclosure of Interests</h3> Gizem Ayan: None declared, Sinem Nihal Esatoglu: None declared, Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Vedat Hamuryudan Consultant for: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB,