Clinical Utility and Cost Savings in Predicting Inadequate Response to Anti-TNF Therapies in Rheumatoid Arthritis.
Clinical Utility and Cost Savings in Predicting Inadequate Response to Anti-TNF Therapies in Rheumatoid Arthritis.
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DOI：
10.1007/s40744-020-00226-3
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发表时间：
2020-12
影响因子：
3.8
通讯作者：
Withers JB
中科院分区：
文献类型：
--
作者：
Bergman MJ;Kivitz AJ;Pappas DA;Kremer JM;Zhang L;Jeter A;Withers JB
PrismRA®检测可识别对抗肿瘤坏死因子（抗TNF）治疗不太可能有反应的类风湿性关节炎（RA）患者。本研究评估了将PrismRA纳入RA患者常规临床护理的临床和财务结局。建立了一个决策分析模型，以评估首次生物治疗后12个月内的临床和经济结局。比较了两种治疗策略：（1）基于175例患者队列观察的临床决策，该队列在常规合成疾病缓解抗风湿药物（csDMARD）治疗失败后接受抗TNF治疗作为其第一种生物制剂;（2）使用PrismRA结果模拟相同人群的临床决策，以告知一线生物制剂治疗选择。模型成本包括生物制药、非生物制药和总医疗成本。根据PrismRA结果计算对抗TNF治疗和患者护理的各种组成部分反应不足的几率。确定抗TNF治疗的预测应答不足导致对一线生物治疗的ACR 50应答增加38%。PrismRA分层人群中12个月内对任何治疗（TNFi和其他）达到ACR 50应答的患者比例比未分层人群高33%（分别为59%和44%）。当根据PrismRA结果对治疗处方进行建模时，对所有财务变量的成本节约进行建模：总成本（总成本降低4%，无效治疗降低19%），总生物药物药房（总成本降低4%，无效治疗降低23%），非生物药物药房（总成本降低2%，无效治疗降低19%）和医疗成本（总成本降低6%，无效治疗降低19%）。女性是显示与抗TNF治疗应答不足相关性最大的临床指标（比值比2.42，95%置信区间1.20，4.88）。如果PrismRA按照模型实施到常规临床护理中，预测哪些RA患者对抗TNF治疗反应不足，每1000名受试患者可节省> 700万美元的总体无效医疗费用，并提高RA的目标DMARD反应率。本文的在线版本（10.1007/s40744-020-00226-3）包含补充材料，可供授权用户使用。
The PrismRA® test identifies rheumatoid arthritis (RA) patients who are unlikely to respond to anti-tumor necrosis factor (anti-TNF) therapies. This study evaluated the clinical and financial outcomes of incorporating PrismRA into routine clinical care of RA patients. A decision-analytic model was created to evaluate clinical and economic outcomes in the 12-month period following first biologic treatment. Two treatment strategies were compared: (1) observed clinical decision-making based on a 175-patient cohort receiving an anti-TNF therapy as their first biologic after failure of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and (2) modeled clinical decision-making of the same population using PrismRA results to inform first-line biologic treatment choice. Modeled costs include biologic drug pharmacy, non-biologic pharmacy, and total medical costs. The odds of inadequate response to anti-TNF therapies and various components of patient care were calculated based on PrismRA results. Identifying predicted inadequate responders to anti-TNF therapies resulted in a modeled 38% increase in ACR50 response to first-line biologic therapies. The fraction of patients who achieved an ACR50 response to any therapy (TNFi and others) within the 12-month period was 33% higher in the PrismRA-stratified population than in the unstratified population (59 vs. 44%, respectively). When therapy prescriptions were modeled according to PrismRA results, cost savings were modeled for all financial variables: overall costs (4% decreased total, 19% decreased on ineffective treatments), total biologic drug pharmacy (4% total, 23% ineffective), non-biologic pharmacy (2% total, 19% ineffective), and medical costs (6% total, 19% ineffective). Female sex was the clinical metric that showed the greatest association with inadequate response to anti-TNF therapies (odds ratio 2.42, 95% confidence interval 1.20, 4.88). If PrismRA is implemented into routine clinical care as modeled, predicting which RA patients will have an inadequate response to anti-TNF therapies could save > $7 million in overall ineffective healthcare costs per 1000 patients tested and increase targeted DMARD response rates in RA. The online version of this article (10.1007/s40744-020-00226-3) contains supplementary material, which is available to authorized users.
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影响因子：
27.4
作者：
Emery P;Burmester GR;Bykerk VP;Combe BG;Furst DE;Barré E;Karyekar CS;Wong DA;Huizinga TW
通讯作者：
Huizinga TW
影响因子：
39.2
作者：
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通讯作者：
Mehrotra A
影响因子：
27.4
作者：
Emery, P.;Bingham, C. O., III;Weinblatt, M. E.
通讯作者：
Weinblatt, M. E.
影响因子：
3.9
作者：
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通讯作者：
Dougados, Maxime
影响因子：
5.7
作者：
Folkersen, Lasse;Brynedal, Boel;Berg, Louise
通讯作者：
Berg, Louise