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Abstract
Objective Early diagnosis and treatment-start is key for rheumatoid arthritis (RA), but the economic effect of an early versus a later diagnosis has never been investigated. We aimed to investigate whether early diagnosis of RA is associated with lower treatment-related costs compared with later diagnosis.
Methods Patients with RA consecutively included in the Leiden Early Arthritis Clinic between 2011 and 2017 were studied (n=431). Symptom duration was defined as the time between symptom onset and first presentation at the outpatient clinic; early treatment start was defined as symptom duration <12 weeks. Information on disease-modifying anti-rheumatic drug use per patient over 5 years was obtained from prescription data from patient records. Prices were used from 2022 and 2012 (proxy of time of prescription) to study the impact of changes in drug costs. Autoantibody-positive and autoantibody-negative RA were studied separately because differences in disease severity may influence costs.
Results Within autoantibody-negative RA, costs were 316% higher in the late compared with the early group (β=4.16 (95% CI 1.57 to 11.1); €4856 vs €1159). When using 2012 prices, results were similar. For autoantibody-positive RA, costs were 19% higher in the late group (€9418 vs €7934, β=1.19, 0.57 to 2.47). This effect was present but smaller when using 2012 prices. Within patients with autoantibody-positive RA using biologicals, late treatment start was associated with 46% higher costs (β=1.46 (0.91 to 2.33)); higher costs were also seen when using 2012 prices.
Conclusion When RA is detected within 12 weeks after symptom onset, treatment-related costs were lower in both autoantibody-negative and autoantibody-positive RA. This study is the first to report how early diagnosis and treatment start impact treatment-related costs.
- Rheumatoid Arthritis
- Biological Therapy
- Anti-Citrullinated Protein Antibodies
- Economics
- Rheumatoid Factor
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request via the corresponding author.
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- Rheumatoid Arthritis
- Biological Therapy
- Anti-Citrullinated Protein Antibodies
- Economics
- Rheumatoid Factor
Data availability statement
Data are available upon reasonable request. Data are available upon reasonable request via the corresponding author.
Footnotes
Handling editor Josef S Smolen
X @elisevmulligen
Contributors All authors made substantial contributions to the design of the work, acquisition of data or their interpretation. EvM performed the statistical analysis. EvM wrote the first draft. All other authors participated in the final draft and reviewed it critically. EvM, MR-vM and AvdH-vM accept full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish. EvM is the guarantor.
Funding This work was funded by ZonMW, Efficiency grant number 10390012110002 and the Dutch Arthritis Society.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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