University of Twente Student Theses

Login

Quantifying the cost impact of withdrawing biologic TNF-α DMARDs in children with juvenile idiopathic arthritis

Florax, Anna A. (2022) Quantifying the cost impact of withdrawing biologic TNF-α DMARDs in children with juvenile idiopathic arthritis.

[img] PDF
943kB
Abstract:Background: The cost impact of withdrawing biologic DMARDs (bDMARDs) in JIA patients in clinically inactive disease is currently unknown. The aim of this study is to quantify the difference in costs from a societal perspective of hospital-associated resource (including medication use) between the period before starting TNF-α bDMARDs withdrawal and the two years after starting TNF-α bDMARDs withdrawal (abrupt discontinuation vs. taper) in JIA patients <18 years old, after they achieved clinically inactive disease on TNF-α bDMARDs. Methods: This study is a retrospective analysis of prospective data from electronic medical records of JIA patients treated in the Wilhelmina Children’s Hospital (Utrecht, the Netherlands), aged <18 years between 8 April 2011 and 8 April 2022, and treated with TNF-α bDMARDs, which were abruptly discontinued or tapered during this period. The hospital-associated resource (including medication use) from a societal perspective were extracted during 1) the period of clinically inactive disease (i.e. pre-withdrawal) and compared to the costs within 2a) the first after starting TNF-α bDMARDs withdrawal (i.e. first year post-withdrawal) and 2b) the second year after starting withdrawal (i.e. second year post-withdrawal). All costs were documented as mean annual costs for the following categories: total, medication, rheumatology visits and telephone consultations, radiology investigations, laboratory testing, hospitalisations, and procedures under anaesthesia. The paired t-test was used to evaluate the significance of the difference in costs between the 1) pre-withdrawal period and 2a) first year post-withdrawal and 2b) second year post-withdrawal. Moreover, a subgroup analysis was conducted to evaluate the annual cost differences between patients who abruptly discontinued TNF-α bDMARDs and patient who tapered TNF-α bDMARDs, using the Mann-Whitney U test. In addition, two deterministic sensitivity analyses were performed to test the robustness of the results, and the analysis is conducted from a hospital perspective, in which societal costs were excluded. All tariffs were obtained from the Dutch Costing Manual, Dutch Healthcare Authority and National Health Care Institute. Results: 56 patients with JIA were included of whom 26 abruptly discontinued and 30 tapered TNF-α bDMARDs. The mean annual total costs per patient are =C9,856 in the pre-withdrawal period (mean follow-up of 428 days) and decrease significantly to =C5,305 (-46.2%, p<0.05) in the first year post-withdrawal period and significantly to =C7,153 (-27.4%, p<0.05) in the second year post-withdrawal. 7.3%, 15.3% and 9.6% of these annual costs can be attributed to societal costs in the pre-withdrawal period, first year post-withdrawal and second year post-withdrawal, respectively. The medication accounts for the majority of the total costs, namely 82.1%, 63.2% and 76.9% for the pre-withdrawal period, first year post-withdrawal period and second year post-withdrawal period, respectively. When distinguishing between withdrawal strategies, mean annual costs per patient within the first year post-withdrawal reduce by 57.6% and 36.2% compared to the pre-withdrawal period, for the abrupt discontinuation and taper group, respectively. In the second year post-withdrawal, the mean annual costs reduce by 30.2% and 24.8% compared to the pre-withdrawal period for the abrupt discontinuation and taper group, respectively. However, the abrupt discontinuation group and taper group do not significantly differ in cost differences between the 1) pre-withdrawal period and 2a) first year post-withdrawal and 2b) second year post-withdrawal. Conclusions: Withdrawing TNF-α bDMARDs is cost-saving compared to the period before starting TNF-α bDMARD withdrawal in JIA patients <18 years old, after they reached clinically inactive disease on TNF-α bDMARDs. Greater cost reductions are found between the pre-withdrawal period and first year post-withdrawal than between the pre-withdrawal period and second year post-withdrawal, especially for the patients who abruptly discontinued TNF-α bDMARD use. The two withdrawal strategies (i.e. abrupt discontinuation vs. taper) do not differ significantly in achieved cost reductions.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine, 83 economics
Programme:Health Sciences MSc (66851)
Link to this item:https://purl.utwente.nl/essays/91183
Export this item as:BibTeX
EndNote
HTML Citation
Reference Manager

 

Repository Staff Only: item control page