THU0653 Changes in rheumatology provision and practice in a publicly-funded single payer healthcare system

J. Widdifield, S. Bernatsky, V. Ahluwalia, C. Barber, L. Eder, C. Hofstetter, B. Kuriya, V. Ling, A. Lyddiatt, M. Paterson, J. Pope, C. Thorne
2018 THURSDAY, 14 JUNE 2018   unpublished
The cost-effectiveness of different biologic therapies is an important component in guiding treatment decisions for patients with rheumatoid arthritis (RA). Objectives: To compare drug and adverse event costs and cost per successful clinical response with tocilizumab (TCZ) monotherapy vs adalimumab (ADA) monotherapy in patients with RA. Methods: Patients in the ADACTA trial 1 were randomised to either TCZ 8 mg/kg intravenously every 4 weeks or ADA 40 mg subcutaneously every 2 weeks as
more » ... weeks as monotherapy for 24 weeks. Drug costs of $397.71/80 mg vial for TCZ (plus $136 administration cost per infusion) and $2220.62/40 mg for ADA were based on Wholesale Acquisition Costs (WAC) drug prices (July 2017). Outcomes included patient-level drug costs and cost of hospitalisation due to adverse events, and cost per response. Cost per response was calculated by dividing the mean drug plus administration cost by the proportion of patients achieving Disease Activity Score-28 joints (DAS28) <2.6 (remission) or American College of Rheumatology response criteria 20%/50%/70% (ACR20/ACR50/ACR70). The proportions of patients achieving DAS28 <2.6, ACR 20, ACR50 and ACR70 were 39.9%, 65.0%, 47.2% and 32.5% for TCZ, respectively, and 10.5%, 49.4%, 27.8% and 17.9% for ADA, respectively; p<0.0001, p=0.0038, p=0.0002, p=0.0023 for TCZ vs ADA, respectively. Hospitalisation costs were calculated using the daily hospital cost of $2433 (2017) and number of hospital days. Results: Among the 163 patients treated with TCZ and 162 with ADA, mean total drug and administration costs per patient over 24 weeks were $16,674.74 and $23,357.63, respectively. Mean drug and administration costs were lower per each clinical response achieved with TCZ compared with ADA Background: The global shortage of rheumatologists is an increasing concern. Statistics from physician surveys have projected changes in the workforce composition (ageing, feminization, and generational trends), which have implications for the workforce clinical activity. In order to adequately document the issues and potential solutions, more detailed information is needed regarding clinical activity, demographic changes and the implications of these, in a population-based sample. Objectives: To describe changes in the number, demographics and clinical activity of Ontario rheumatologists over the past decade. Methods: We analysed administrative health data from 2000 to 2013 in Ontario, Canada, where all 13 million residents are covered by a publicly funded healthcare system. Rheumatologists, and their characteristics, were identified using a validated physician registry. We used fee-for-service billing claims to quantify clinical activity levels expressed as full-time equivalents (FTE). Physicians below the 40th percentile of total billings were classified as providing less clinical activity
doi:10.1136/annrheumdis-2018-eular.3372 fatcat:iwbzxwxru5aopejmn3t37lqwsi