Achieving early disease control and reducing indirect cost – the crystal registry in hong kong rheumatoid arthritis patients

Background: Rheumatoid arthritis is associated with irreversible joint erosion, jeopardising patients’ work ability and incurs substantial indirect cost to the society. While early treatment yield clinical efficacy, its economic outcome remains uncertain in Hong Kong. Objectives: To ascertain the effect of early disease control in early RA subjects on indirect cost. Methods: This was a multi-centre, prospective cohort study involved 13 hospitals in Hong Kong. Subjects underwent intensive treatment scheme aiming at remission. Early disease control was defined as achieving remission or low disease activity(LDA) at month 6 indicated by DAS-28 score. Results: Seventy early RA patients [53 (75.7%)Female, mean age: 53±11 years, mean disease duration 30±11 months] were included in this analysis. Forty-two(60%) subjects achieved early disease control. Subjects with or without early disease control were comparable at baseline. Twenty-two(31.4%) subjects had non-zero indirect cost[median(IQR) indirect cost: USD162(76–317)]. Among them, early disease control non-achievers(n=11) had significantly higher indirect cost than achievers[median(IQR) indirect cost: USD317(133–934) vs USD95, p=0.008](figure 1). Using multivariate linear regression, after adjusting for age, gender, baseline pain score, fatigue level, physical and mental condition, every 1-unit increase in DAS score at month 6 was associated with USD82 increase in indirect cost [95% CI: 12–151, p=0.022]. When disease activity was categorised, not achieving remission/LDA was associated with USD165 increase in indirect cost [95% CI: 21–310, p=0.025] (table 1). Model 1 – DAS score as continuous variable Model 2 – DAS score categorised as early disease control or not Abstract AB1270 – Figure 1 Conclusions: Early intensive treatment with early disease control yield lower indirect cost. Health care system shall consider reallocating adequate resource for managing early arthritis patients to reduce indirect cost related to disease. Acknowledgements: This is to acknowledge the Hong Kong Society of Rheumatology Education and Research Foundation for supporting this project. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2018-eular.2472 Abstract AB1270 – Table 1 – Regression analysis on indirect cost Univariate Analyses Multivariate Analyses* β 95% CI p Model 1 Model 2 β 95% CI p β 95% CI p Age −32.5 −242.4 to 5351.7 0.211 −6.4 −66.2 to 53.3 0.830 −11.4 −68.0 to 45.2 0.688 Gender, female −119.6 −1491.0 to 1251.9 0.862 66.4 −1601.9 to 1734.8 0.937 63.6 −1597.7 to 1725.0 0.939 Disease duration (months) 44.5 −7.5 to 96.7 0.093 17.7 −42.4 to 77.4 0.561 14.2 −48.8 to 77.2 0.632 Baseline VAS pain score 300.8 88.3 to 513.2 0.006 280.5 72.5 to 488.5 0.009 271.4 62.2 to 480.6 0.012 Baseline HAQ 893.8 −15.7 to 1083.3 0.054 −223.5 −1760.2 to 1313.2 0.772 −397.6 −1641.4 to 846.2 0.525 Baseline FACIT −63.9 −114.9 to −12.8 0.015 −19.6 −0.4 to 0.6 0.635 −40.7 −127.2 to 45.762 0.350 Baseline SF36 PCS −30.0 −660.0 to −0.017 0.050 17.7 −27.3 to 62.8 0.434 12.4 −38.1 to 62.9 0.625 Baseline SF 36 MCS −42.6 −72.8 to −12.4 0.006 −26.9 −63.4 to 9.63 0.146 −27.9 −64.3 to 8.6 0.131 Month 6 DAS CRP Score 695.4 137.4 to 1253 0.015 634.8 96.1 to 1175.4 0.022 - - - Cannot achieve early remission/LDA 1465.3 318.1 to 2612 0.013 - - - 1287.5 164.3 to 2410.7 0.025 Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1729Session: Public health, health services research and health economics