1365: Economic impact of early treatment and strict disease control in rheumatoid arthritis: a cost-minimization approach concerning biological therapy

Background/Purpose: Rheumatoid arthritis (RA) is a chronic, progressive, potentially disabling autoimmune disease, with substantial economic burden, particularly related to its high-cost pharmacological treatment. Early treatment, goal-oriented management (treat to target, T2T), and strict disease control have been shown to modify the course of the disease, and might influence its economic impact.This cost-minimization study aimed to estimate the financial impact associated with biological disease-modifying antirheumatic drugs (bDMARDs) use in patients with RA treated with a strict control strategy versus conventional management under real-life conditions.

Methods: 256 participants meeting the ACR/EULAR 2010 classification criteria for RA, diagnosed within one year of symptoms onset, distributed into one strict control and three conventional management groups (64 patients per group) were assessed. Cost data for a comprehensive range of bDMARDs available in clinical practice during the study period (2018–2022) were sourced from public procurement records, based on annual maintenance doses in adults with RA. Potential cost reduction was estimated by multiplying the difference in bDMARD usage proportions by the weighted cost (based on market share) over one- and five-year horizons. Deterministic (Tornado diagram) and probabilistic (Monte Carlo) sensitivity analyses were performed using minimum and maximum parameter values to address uncertainty. A 95% confidence interval (CI) was applied to the proportional differences in bDMARD use between groups. Beta distributions were used for proportions (bDMARD use and market share), and gamma distributions for costs and patient counts. All costs are presented in U.S. dollars, adjusted for inflation to reflect May 2024 price levels.

Results: Table 1 summarizes the background characteristics and clinical outcomes of the study groups. Average annual spending on bDMARDs during the study period amounted to approximately USD 151 million. National projections based on the strict control scenario suggested potential annual savings of USD 83.94 (95% CI: USD 40.13–113.97) million in 2024, representing a 55.6% (95% CI: 26.6%-75.5%) reduction in bDMARD expenditures compared to conventional management. Assuming stable population size, therapeutic strategies, and drug prices, cumulative savings over five years could reach up to USD 419.73 (95%CI: USD 200,65 - USD 569,85) million (Figures 1 and 2).

Conclusion: A strict control strategy compared to conventional management in early RA showed substantial expenditure reductions concerning the usage of bDMARD, along with improved clinical outcomes. These findings support that, under real-life conditions of healthcare systems, the implementation of strict disease control in early RA is a feasible and potentially cost-saving approach.