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Long-term costs and outcomes in psoriatic arthritis patients not responding to conventional therapy treated with tumour necrosis factor inhibitors: the extension of the Psoriatic Arthritis Cost Evaluation (PACE) study


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15

 

  1. Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy. i.olivieri@ospedalesancarlo.it
  2. Researh Centre on Public Health (CESP), University of Milan-Bicocca, and Fondazione Charta, Milan, Italy.
  3. Department of Pharmaceutical Chemistry and Toxicology, University Federico II of Naples, Italy.
  4. Rheumatic Disease Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
  5. Rheumatology Unit II, University of Cagliari, Monserrato, Italy.
  6. Rheumatology Unit, Department of Healthy Sciences, University of Molise, Campobasso, Italy.
  7. Dipartimento di Clinica e Terapia Medica, Rheumatology Unit, Università di Roma 'La Sapienza', Rome, Italy.
  8. Rheumatic Disease Unit, 2nd Division of Medicine, Prato Hospital, Prato, Italy.
  9. Researh Centre on Public Health (CESP), University of Milan-Bicocca, and Fondazione Charta, Milan, Italy.
  10. Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy.
  11. Rheumatology Unit II, University of Cagliari, Monserrato, Italy.
  12. Rheumatology Department, University of Florence, Italy.
  13. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Italy.
  14. Rheumatology Research Unit, University Federico II of Naples, Italy.
  15. Researh Centre on Public Health (CESP), University of Milan-Bicocca, and Fondazione Charta, Milan, Italy.

for the PACE Working Group

CER8616
2016 Vol.34, N°1
PI 0068, PF 0075
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PMID: 26633622 [PubMed]

Received: 18/05/2015
Accepted : 24/07/2015
In Press: 03/12/2015
Published: 10/02/2016

Abstract

OBJECTIVES:
Poor information on long-term outcomes and costs on tumour necrosis factor (TNF) inhibitors in psoriatic arthritis (PsA) are available. Our aim was to evaluate long-term costs and benefits of TNF- inhibitors in PsA patients with inadequate response to conventional treatment with traditional disease-modifying anti-rheumatic drugs (tDMARDs).
METHODS:
Fifty-five out of 107 enrolled patients included in the study at one year, completed the 5-year follow-up period. These patients were enrolled in 8 of 9 centres included in the study at one year. Patients aged older than 18 years, with different forms of PsA and failure or intolerance to tDMARDs therapy were treated with anti-TNF agents. Information on resource use, health-related quality of life (HRQoL), disease activity, function and laboratory values were collected at baseline and through the 5 years of therapy. Costs (expressed in Euro 2011) and utility (measured by EQ-5D instrument) before TNF inhibitor therapy and after 1 and 5 years were compared.
RESULTS:
The majority of patients (46 out of 55; 83.6%) had a predominant or exclusive peripheral arthritis and 16.4% had predominant or exclusive axial involvement. There was a statistically significant improvement of the most important clinical variables after 1 year of follow-up. These improvements were maintained also after 5 years. The direct costs increased by approximately €800 per patient-month after 1 year, the indirect costs decreased by €100 and the overall costs increased by more than €700 per patient-month due to the cost of TNF inhibitor therapy. Costs at 5 year were similar to the costs at 1 year. The HRQoL parameters showed the same trends of the clinical variables. EQ-5D VAS, EQ-5D utility and SF-36 PCS score showed a significant improvement after 1 year, maintained at 5 years. SF-36 MCS showed an improvement only at 5 years.
CONCLUSIONS:
The results of our study suggest that TNF blockers have long-term efficacy. The higher cost of TNF inhibitor therapy was balanced by a significant improvement of HRQoL, stable at 5 years of follow-up. Our results need to be confirmed in larger samples of patients.

Rheumatology Article