New Manchester study evaluates steps towards cost-effectiveness of implementing a personalised treatment approach for rheumatoid arthritis (RA) patients

New research findings published in Rheumatology aim to assess the initial steps of implementing a personalised treatment approach for rheumatoid arthritis (RA) patients in the NHS.

Biologic drugs used to treat RA act by targeting molecules that cause inflammation in the body. Whilst they have transformed the treatment of RA patients, they now represent some of the highest cost drugs in the NHS across all diseases.

A targeted approach using biomarkers (tests that can help predict response) would help the management of patients, as clinical staff would be able to predict which patients are unlikely to respond to a biologic drug sooner after they start treatment, enabling them to switch to an alternative that is more effective for them as soon as possible.

Previous work has shown that drug antibodies and biologic drug levels are promising biomarkers of treatment response. However, before such tests can be used in clinical practice the actual costs of implementing these in the NHS needed to be considered.

In a study led by Dr Meghna Jani, Centre for Musculoskeletal Research at The University of Manchester, scientists wanted to assess the cost effectiveness of the treatment options using microcosting, a way of calculating the detailed costs, not just of the tests themselves but also the hidden costs of staff time and other resources required to collect and perform the tests, to  determine the true cost per patient of providing such tests.

The aim of the research was to identify and quantify the resource used and associated costs required to introduce drug level and drug antibody testing to assess response to biologic drugs in routine practice.

Resource use and costs per patient were identified using four stages including setting out patient pathways for using such tests; estimating what resource would be needed; identifying of the cost at every stage of the pathway and calculating of the total costs per patient.

The costs for biologic drug level and drug antibodies tested at the same time were just over £152 per patient. The additional appointment required to obtain blood tests before the patient was due their next biologic injection, was surprisingly the largest part of the costs per patient, standing at 67% of the total cost.

Anne Barton, Professor of Rheumatology and BRU Inflammatory Arthritis in Adults Theme Lead, explained:

The results of this study are the first step towards introducing these tests into clinical practice. The calculated cost of the test will be helpful in the future to find out whether it would save the NHS money and lead to better outcomes for patients if UK hospitals were to incorporate these types of tests into clinical practice.

This research was supported by the NIHR Manchester Musculoskeletal Biomedical Research Unit and performed in collaboration with the Manchester Centre for Health Economics.

Read the paper in full.