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Do Biologic Therapies for Rheumatoid Arthritis Offset Treatment-Related Resource Utilization and Cost? A Review of the Literature and an Instrumental Variable Analysis

  • Health Economics and Quality of Life (N Tsao, Section Editor)
  • Published:
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Abstract

Purpose of Review

One justification for using expensive biologic therapy in rheumatoid arthritis (RA) has been that it can reduce future healthcare utilization such as joint surgeries and physician visits. However, the evidence to support this assertion is unclear. We conducted a review of the literature for studies which have analyzed the trends in resource use of RA patients, and then undertook a retrospective observational analysis of a Canadian administrative database using instrumental variable methods.

Recent Findings

Our review found a trend in reduced resource utilization prior to the introduction of biologics and no evidence that biologic therapies have specifically contributed to this reduction. Our observational analysis, which overcame some of the epidemiological challenges with determining the influence of biologics on resource utilization, found a possible reduction in other medications but possible increases rather than decreases in physician visits and hospitalizations. However, our sample was not sufficiently large to make definitive conclusions.

Summary

Over 15 years since the introduction of biologics for RA, no evidence exists supporting the assumption that biologic therapies reduce future healthcare utilization. While such a question is challenging to generate evidence for, and so an absence of evidence does not suggest that the hypothesis is incorrect, an instrumental variable analysis using sufficient data could provide definitive evidence.

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Author information

Authors and Affiliations

  1. Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada

    Nick Bansback, Eric Fu, Huiying Sun, Daphne Guh, Wei Zhang, Katherine Milbers & Aslam H. Anis

  2. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Nick Bansback, Wei Zhang & Aslam H. Anis

  3. Arthritis Research Canada, Vancouver, BC, Canada

    Nick Bansback, Diane Lacaille & Aslam H. Anis

  4. Faculty of Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    Diane Lacaille

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Correspondence to Nick Bansback.

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Conflict of Interest

Eric Fu, Huiying Sun, Daphne Guh, Wei Zhang, Diane Lacaille, Katherine Milbers, and Aslam H. Anis, declare that they have no conflict of interest.

Dr. Bansback reports grants from Canadian Rheumatology Association during the conduct of the study.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclosure of Funding

This study was funded by the Canadian Initiative for Outcomes in Rheumatology Care, part of the Canadian Rheumatology Association. Some of the authors have received research funding from manufacturers of biologics in rheumatoid arthritis, but none of these funders have had any role in the study, and the results go against manufacturer’s interests.

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Bansback, N., Fu, E., Sun, H. et al. Do Biologic Therapies for Rheumatoid Arthritis Offset Treatment-Related Resource Utilization and Cost? A Review of the Literature and an Instrumental Variable Analysis. Curr Rheumatol Rep 19, 54 (2017). https://doi.org/10.1007/s11926-017-0680-6

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  • DOI: https://doi.org/10.1007/s11926-017-0680-6

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