Estimating the monetary value of the annual productivity gained in patients with early rheumatoid arthritis receiving etanercept plus methotrexate: interim results from the PRIZE study

Wei Zhang, Nick Bansback, Huiying Sun, Ronald Pedersen, Sameer Kotak, Aslam H Anis, Wei Zhang, Nick Bansback, Huiying Sun, Ronald Pedersen, Sameer Kotak, Aslam H Anis

Abstract

Objective: To measure and value the impact of combined etanercept (ETN) and methotrexate (MTX) therapy on work productivity in patients with early rheumatoid arthritis (RA) over 52 weeks.

Methods: MTX- and biological-naïve patients with RA (symptom onset ≤12 months; Disease Activity Score based on a 28-joint count (DAS28) >3.2) received open-label ETN50/MTX for 52 weeks. The Valuation of Lost Productivity (VOLP) questionnaire, measuring paid and unpaid work productivity impacts, was completed approximately every 13 weeks. Bootstrapping methods were used to test changes in VOLP outcomes over time. One-year productivity impacts were compared between responders (DAS28 ≤3.2) at week 13 and non-responders using zero-inflated models for time loss and two-part models for total costs of lost productivity.

Results: 196 patients were employed at baseline and had ≥1 follow-up with VOLP. Compared with baseline, at week 52, patients gained 33.4 h per 3 months in paid work and 4.2 h per week in unpaid work. Total monetary productivity gains were €1322 per 3 months. Over the 1-year period, responders gained paid (231 h) and unpaid work loss (122 h) compared with non-responders, which amounted to a gain of €3670 for responders.

Conclusions: This is the first clinical trial to measure and value the impact of biological treatment on all the labour input components that affect overall productivity. Combination therapy with ETN50/MTX was associated with a significant productivity gain for patients with early RA who were still observed at week 52. Over the 1-year treatment period, responders at week 13 suffered significantly less productivity loss than non-responders suggesting this gain was related to treatment response.

Trial registration number: ClinicalTrials.gov number NCT00913458.

Keywords: DMARDs (biologic); Early Rheumatoid Arthritis; Economic Evaluations.

Figures

Figure 1
Figure 1
Study cohort flowchart. DAS28, Disease Activity Score based on a 28-joint count; VOLP, the Valuation Of Lost Productivity questionnaire.
Figure 2
Figure 2
Plots of 3-month productivity loss and costs at each visit by response at week 13. DAS28, Disease Activity Score based on a 28-joint count.

References

    1. Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am 2001;27:269–81. 10.1016/S0889-857X(05)70201-5
    1. Sokka T, Kautiainen H, Pincus T et al. . Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther 2010;12:R42 10.1186/ar2951
    1. Merkesdal S, Ruof J, Schöffski O et al. . Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthritis Rheum 2001;44:528–34. 10.1002/1529-0131(200103)44:3<528::AID-ANR100>;2-U
    1. Ten Klooster PM, Veehof MM, Taal E et al. . Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment. Ann Rheum Dis 2007;66:1485–90. 10.1136/ard.2007.069765
    1. Puolakka K, Kautiainen H, Möttönen T et al. . Impact of initial aggressive drug treatment with a combination of disease-modifying antirheumatic drugs on the development of work disability in early rheumatoid arthritis: a five-year randomized followup trial. Arthritis Rheum 2004;50:55–62. 10.1002/art.11436
    1. Anis A, Zhang W, Emery P et al. . The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology (Oxford) 2009;48:1283–9. 10.1093/rheumatology/kep239
    1. Verstappen SM, Fautrel B, Dadoun S et al. . Methodological issues when measuring paid productivity loss in patients with arthritis using biologic therapies: an overview of the literature. Rheumatology (Oxford) 2012;51:216–29. 10.1093/rheumatology/ker363
    1. Zhang W, Bansback N, Anis AH. Measuring and valuing productivity loss due to poor health: A critical review. Soc Sci Med 2011;72:185–92. 10.1016/j.socscimed.2010.10.026
    1. Zhang W, Bansback N, Boonen A et al. . Development of a composite questionnaire, the valuation of lost productivity, to value productivity losses: application in rheumatoid arthritis. Value Health 2012;15:46–54. 10.1016/j.jval.2011.07.009
    1. Lenssinck ML, Burdorf A, Boonen A et al. . Consequences of inflammatory arthritis for workplace productivity loss and sick leave: a systematic review. Ann Rheum Dis 2013;72:493–505. 10.1136/annrheumdis-2012-201998
    1. Eriksson JK, Neovius M, Bratt J et al. . Biological vs. conventional combination treatment and work loss in early rheumatoid arthritis: a randomized trial. JAMA Intern Med 2013;173:1407–14. 10.1001/jamainternmed.2013.7801
    1. Neovius M, Simard JF, Askling J et al. . How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop? Ann Rheum Dis 2011;70:1010–15. 10.1136/ard.2010.136812
    1. Puolakka K, Kautiainen H, Pekurinen M et al. . Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients’ sickness absence and gross income: experience from the FIN-RACo trial. Ann Rheum Dis 2006;65:899–904. 10.1136/ard.2005.045807
    1. Emery P, Hammoudeh M, FitzGerald O et al. . Sustained remission with etanercept tapering in early rheumatoid arthritis. N Engl J Med 2014;371:1781–92. 10.1056/NEJMoa1316133
    1. Emery P, Wiland P, Spieler W et al. . Impact of etanercept-methotrexate therapy on patient-reported out-comes in rheumatoid arthritis patients with up to 12 months of symptoms [Abstract]. Arthritis Rheum 2012;64:S160.
    1. Zhang W, Bansback N, Kopec J et al. . Measuring time input loss among patients with rheumatoid arthritis: validity and reliability of the Valuation of Lost Productivity questionnaire. J Occup Environ Med 2011;53:530–6. 10.1097/JOM.0b013e318218abf1
    1. van Buuren S. Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 2007;16:219–42. 10.1177/0962280206074463
    1. World Bank. PPP conversion factor. (accessed 2 Oct 2014).
    1. Eurostat. Mean hourly earnings by sex, economic activity and occupation (earn_ses10_47). (accessed 12 Sep 2014).
    1. Manly BFJ. Randomization, bootstrap and Monte Carlo methods in biology. 3rd edn Boca Raton, FL: Chapman and Hall/CRC, 2006.
    1. MacKinnon JG. Bootstrap methods in econometrics. Econ Rec 2006;82:S2–18. 10.1111/j.1475-4932.2006.00328.x
    1. Efron B, Tibshirani RJ. An introduction to the bootstrap. CRC Press, 1994.
    1. Verstappen SM, Bijlsma JW, Verkleij H et al. . Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Rheum 2004;51:488–97. 10.1002/art.20419
    1. De Croon EM, Sluiter JK, Nijssen TF et al. . Predictive factors of work disability in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 2004;63:1362–7. 10.1136/ard.2003.020115
    1. van Vollenhoven RF, Cifaldi MA, Ray S et al. . Improvement in work place and household productivity for patients with early rheumatoid arthritis treated with adalimumab plus methotrexate: work outcomes and their correlations with clinical and radiographic measures from a randomized controlled trial companion study. Arthritis Care Res (Hoboken) 2010;62:226–34. 10.1002/acr.20072
    1. van Vollenhoven RF, Ferraccioli G, Breedveld F et al. . Effect of adalimumab combination therapy on work performance: results from a companion study to PREMIER [Abstract]. Arthritis Rheum 2007;56:S88.
    1. Zhang W, Bansback N, Guh D et al. . Short-term influence of adalimumab on work productivity outcomes in patients with rheumatoid arthritis. J Rheumatol 2008;35:1729–36.
    1. Olofsson T, Petersson IF, Eriksson JK et al. . Predictors of work disability during the first 3 years after diagnosis in a national rheumatoid arthritis inception cohort. Ann Rheum Dis 2014;73: 845–53. 10.1136/annrheumdis-2012-202911
    1. Koopmanschap MA, Rutten FF, van Ineveld BM et al. . The friction cost method for measuring indirect costs of disease. J Health Econ 1995;14:171–89. 10.1016/0167-6296(94)00044-5
    1. Jacob-Tacken KH, Koopmanschap MA, Meerding WJ et al. . Correcting for compensating mechanisms related to productivity costs in economic evaluations of health care programmes. Health Econ 2005;14:435–43. 10.1002/hec.948
    1. Krol M, Brouwer WB, Severens JL et al. . Productivity cost calculations in health economic evaluations: correcting for compensation mechanisms and multiplier effects. Soc Sci Med 2012;75:1981–8. 10.1016/j.socscimed.2012.07.012

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner