RESEARCH - RA patients treated with TNF-antagonists increase their participation in the workforce

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Ann Rheum Dis. Published Online First: 25 May 2009. doi:10.1136/ard.2009.108035

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Extended Report

Rheumatoid arthritis (RA) patients treated with TNF-antagonists

increase their participation in the work-force – potential for

significant long-term indirect cost gains. Data from a

population-based registry

Augustsson 1*, Neovius 2, Cheryl Cullinane-Carli 1,

Staffan Eksborg 3 and F van Vollenhoven 1

1 Dept of Medicine, Rheumatology Unit, Karolinska Institute, Sweden

2 Dept of Medicine, Centre for Pharmacoepidemiology, Karolinska

Institute, Sweden

3 Dept of Woman and Child Health, Childhood Cancer Research Unit,

Karolinska Institute, Sweden

Abstract

Objective: To investigate the effect of TNF-antagonist treatment on

work-force participation in rheumatoid arthritis (RA) patients.

Methods: Data from the Stockholm anti-TNF follow-up registry (STURE)

were used in this observational study. RA patients (n=594) aged

18-55y, (mean±SD 40±9) followed for up to five years were included

with hours worked/week as the main outcome measure. Analyses were

performed unadjusted and adjusted for baseline age, disease duration,

HAQ, DAS28 and pain score.

Results: At baseline patients worked a mean 20h/week (SD 18). In

unadjusted analyses, significant improvements in hours worked/week

were observed in patients already at six months +2.4h (1.3 to 3.5;

mean, 95% confidence interval (95%CI)) with further increases compared

to baseline at the one-year (+4.0h, 2.4 to 5.6) and two-year follow-up

(+6.3h, 4.2 to 8.4). The trajectory appeared to stabilise at the 3year

(+6.3h, 3.6 to 8.9), 4year (+5.3h, 2.3 to 8.4) and 5year follow-up

(+6.6h, 3.3 to 10.0). In a mixed piecewise linear regression model,

adjusted for age, sex, baseline disease activity, function and pain,

an improvement of +4.2h/week was estimated for the first year followed

by an added improvement of +0.5h/week annually during the years

thereafter. Over five years of treatment, the expected indirect cost

gain corresponded to 40% of the annual anti-TNF drug cost in patients

continuing treatment.

Conclusion: Data from this population-based registry indicate that

biologic therapy is associated with increases in work-force

participation in a group typically expected to experience

progressively deteriorating work ability. This could result in

significant indirect cost benefits to society.

http://ard.bmj.com/cgi/content/abstract/ard.2009.108035v1?papetoc

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