FRI0647 COST-EFFECTIVENESS OF RHEUMATOLOGY ULTRASOUND: RETROSPECTIVE AUDIT OF THE AINTREE ULTRASOUND CLINIC
Authors: Laura Ranieri, Robert N. Thompson, Jagdish R. Nair, Cristina Estrach
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Ultrasound is useful to guide escalation of synthetic disease-modifying antirheumatic drugs (sDMARDs) and optimization of biologic DMARD therapy (bDMARDs) in inflammatory arthritis. However, there is limited published evidence of the cost effectiveness of the use of ultrasound in selecting patients for treatment tapering or escalation avoidance [1]. <h3>Objectives</h3> To evaluate the usefulness of a Rheumatology-led Ultrasound Clinic. <h3>Methods</h3> Retrospective descriptive analysis of patients evaluated in the Aintree Ultrasound Clinic between January and September 2018. Our Ultrasound Clinic runs once a week and the scans are performed by expert rheumatologists (2 EFSUMB level 3, 1 advance EULAR level). Patients can be referred by specialist nurses or by other rheumatologists. Synovitis is assessed following EULAR/OMERACT guidelines. <h3>Results</h3> 113 patients were analysed and 10 patients were excluded (7 did not attend and 3 excluded due to not enough information available). The mean time from referral to ultrasound was 48.17 days (SD 20.21). Forty seven patients (42%) were referred by a doctor and 65 patients (58%) by a specialist nurse. Rheumatoid arthritis was the most frequent diagnosis with 74 patients (66%), other inflammatory arthritis in 23 patients (23%) and other non inflammatory conditions in 16 patients (14%). The indication for scan was to exclude subclinical inflammation (n=91, 81%), to exclude inflammatory arthritis (n=15, 13%) with not clear referral question in 7 patients (6%). The ultrasound was positive for inflammation (defined as &gt;= power doppler OMERACT grade 2 in at least 1 joint)) in 37 patients (33%) all of whom had their treatment changed: sDMARD escalation (n=10), initiation bDMARD(n= 4), change of bDMARD(n=2) and steroid therapy (intraarticular or intramuscular injection) the same day of the scan (n= 28). Fifty eight patients were on sDMARD treatment: 14 patients had a change in treatment based on the scan (4 patients started biologic drugs, 10 patients had sDMARD escalation). There was no change of treatment in 44 patients, 7 of whom were being considered for bDMARDs before scan. Three of the 29 patients on bDMARD had a change of treatment based on the scan (2 changed to other biologic, in 1 patient another sDMARD was added). Steroids were administered the same day of the scan to 28 patients (intraarticular injection 10; intramuscular injection 18). <h3>Conclusion</h3> Ultrasound altered our management in most patients (n=108, 96%). Avoiding escalation to biologics in 7 patients who met clinical criteria saved an estimate of £35,000. We conclude that point of care ultrasound in patients with inflammatory arthritis is cost effective, not only in saving unnecessary escalation to high cost drugs but by prompt treatment of those with active disease. <h3>References</h3> [1] Simpson E, Hock E, Stevenson M, Wong R, Dracup N, Wailoo A, et al. What is the added value of ultrasound joint examination for monitoring synovitis in rheumatoid arthritis and can it be used to guide treatment decisions? A systematic review and cost-effectiveness analysis. Health Technol Assess 2018;22(20). <h3>Disclosure of Interests</h3> None declared