July 23, 2019
By Julie Gould
Peter M ten Klooster, PhD, assistant professor at the University of Twente in Enschede in the Netherlands, discusses the importance of achieving early remission for patients with rheumatoid arthritis (RA). He highlights the major takeaways for payers, which include substantial cost savings for patients achieving early remission.
Please tell us about yourself.
I’m an assistant professor at the University of Twente in Enschede, The Netherlands. I have a PhD in patient-reported outcomes research in rheumatology. Most of my research is conducted within the Arthritis Center Twente, a cooperation between rheumatologists from the Medisch Spectrum Twente hospital and The University of Twente. The rheumatology department of Medisch Spectrum Twente initiated the real-world treat-to-target study in rheumatoid arthritis from which the data were used for this study.
What are the challenges in achieving early remission among patients with RA?
The current treatment paradigm of intensive treatment to the target of remission or low disease activity has been shown in many studies to be very effective for the fast majority of patients. However, for a subgroup of patients it appears to be difficult to achieve remission or low disease activity in the long term, despite increasingly intensive treatment. One of the factors that may predict long-term achievement of remission is the time it takes to achieve remission form the start of treatment. This study explored this factor by comparing a range of long-term outcomes in patients that did or did not achieve early remission.
How is the cost of care and health care utilization impacted for patients who achieve early remission?
The findings showed that costs of care after two and three years of treatment were much lower in patients that achieved early remission. This was mainly the result of much lower use of expensive biologicals in the latter group, but costs for traditional disease-modifying anti-rheumatic drugs were also significantly lower. Finally, health care resources were saved in terms of significantly lower consolation costs.
What can payers learn and takeaway from your study?
Achieving early remission saves substantial costs in the long run. It may be beneficial to intensify treatment even further in the first 3 three months in patients with insufficient response or switch to alternative therapies earlier in these patients.
What knowledge gaps still exist regarding cost of care for patients in early remission?
The potential benefits of early remission on both short term and long-term indirect cost, such as work disability, is still largely unclear.
Ten Klooster PM, Oude Voshaar MAH, Fakhouri W, et al. Long-term clinical, functional, and cost outcomes for early rheumatoid arthritis patients who did or did not achieve early remission in a real-world treat-to-target strategy [published online June 3, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04600-7