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Báo cáo y học: "The loss of health status in rheumatoid arthritis and the effect of biologic therapy: a longitudinal observational study"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: The loss of health status in rheumatoid arthritis and the effect of biologic therapy: a longitudinal observational study. | Wolfe and Michaud Arthritis Research Therapy 2010 12 R35 http arthritis-research.eom content 12 2 R35 RESEARCH ARTICLE Open Access The loss of health status in rheumatoid arthritis and the effect of biologic therapy a longitudinal observational study Frederick Wolfe Kaleb Michaud Abstract Introduction The long-term course of rheumatoid arthritis RA in terms of health status is not well understood nor is the degree of effectiveness of biologic therapy in the community. We modeled the progression of loss of health status and measured incremental costs and effectiveness of biologic therapy in the community. Methods We studied change in function and health status in 18 485 RA patients 135 731 observations at six-month intervals for up to 11 years including a group of 4 911 patients 59 630 observations who switched to biologic therapy from non-biologic therapy. We measured the SF-36 Physical Component PCS and Mental Component MCS Summary scales the EQ-5D health utility scale and the Health Assessment Questionnaire HAQ disability scale and we calculated treatment and direct medical costs. Results RA onset caused an immediate and substantial reduction in physical but not mental health status. Thereafter the progression of dysfunction in RA was very slow HAQ 0.016 units and PCS -0.125 units annually only slightly worse than the age and sex-adjusted US population. We estimated biologic treatment to improve HAQ by 0.29 units PCS by 5.3 units and EQ-5D by 0.05 units over a 10-year period. The estimated incremental 10year total direct medical cost for this benefit was 159 140. Conclusions Biologic therapy retards RA progression but its effect is far less than is seen in clinical trials. In the community cost-effectiveness is substantially less than that estimated from clinical trial data. The study results represent the incremental benefit of adding biologic therapy to optimum non-biologic therapy. Introduction Biologic therapy for rheumatoid arthritis RA has been shown to be