Rheumatoid arthritis inpatient days for any reason was about 49,000 per year in the pre-2002 era, but that was reduced about 13 percent a year, to 31,000 hospitalizations in 2010, said Oliver FitzGerald, MBBCh, professor of rheumatology at St. Vincent's University Hospital in Dublin.
"We did not correct these figures for changes in population during the time period of the study," FitzGerald said at a press briefing here at the annual meeting of the American College of Rheumatology (ACR). "The population has increased, so that would only accentuate the difference that we observed."
About one-third of rheumatoid arthritis patients in the prebiologic era were estimated to require joint replacement surgery during their lifetime, FitzGerald said. Studies in the United States and Europe have suggested that these types of surgeries have decreased as patients are treated with biologic agents that slow the progression of disease and inflammation associated with joint destruction and pain, he noted.
"We sought to determine if there was a relationship between anti-TNF drug prescribing and in hospital inpatient days, and specifically muscular-skeletal surgical procedures across Ireland," he said.
To get the answer, FitzGerald and colleagues interrogated the nationwide Hospital In-Patient Enquiry system (HIPE), which contains data from 57 hospitals from 1995 to 2010. They also reviewed national anti-TNF drug prescribing between 2000 and 2010.
They accessed 57,700 records – and, as expected, twice as many rheumatoid arthritis patients were women than men. The mean age of the cohort was 66 years.
When examining muscular-skeletal procedures performed on these patients, FitzGerald observed, "There was a 10 percent per annum decrease, from 550 procedures being performed per annum in the prebiologic era to just over 291 per annum in the more recent years."
That resulted correlated strongly with increasing use of biologics, and represents a 47 percent reduction, he said.
"We broke the data down further and saw there were reductions in hip surgery – a 47 percent reduction, and in knee surgery – a 53 percent reduction," FitzGerald continued.
He noted that the researchers "did not see a reduction in foot-ankle surgery," but added that foot-ankle surgery was very low in the prebiologic era, and it remained low after biologic prescriptions increased.
FitzGerald said the findings of the study led the authors to consider that anti-TNF prescribing is "one of the factors that has led to less hospitalization for rheumatoid arthritis. We are not saying it is the only reason."
"In Ireland at that time, there was an increase in rheumatology consultants and that would have meant patients could see their consultant earlier," he continued. "There were shorter waiting lists. They were able to use methotrexate more effectively. We were beginning at the end of this period to treat to target. All of that would have contributed to improve outcomes."
"Nevertheless, we believe the data are compelling that anti-TNF prescribing is at least one of the factors that affects patient outcomes in Ireland over the past 10 years," he explained.
FitzGerald estimated that direct savings that could be attributable to use of the anti-TNF drugs was about Euro16 million a year ($20 million) in Ireland. Extrapolating those figures to the United States, the savings could amount to $1.5 billion a year.
"When you tighten the control of the disease then there is less of the morbidity with the disease," said Kathryn Dao, MD, associate director of clinical rheumatology at the Baylor Research Institute, Dallas, who moderated the press briefing for the ACR.
"We know that these biologics have improved the lives of our patients," Dao, who did not participate in the study, told MedPage Today.
Source: Use of Biologics in RA Cuts Hospitalizations
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