Tumor Necrosis Factor Antagonists Associated with Reduction in Hospital Admissions for Rheumatoid Arthritis

   Research by Leonard C. Harty, MD, of St. Vincent's University Hospital, Dublin, Ireland, and colleagues has found that increased prescription of tumor necrosis factor inhibitors (TNFi) for rheumatoid arthritis (RA) negatively correlated with reduction in RA hospital inpatient bed days and likely contributed significantly to an estimated €16,000,000 annual savings. TNFi usage also correlated negatively with a reduction in all musculoskeletal surgical procedures (MSKSPs), specifically with both elective hip and knee procedures.

   After reviewing 57,774 RA inpatient records from 1995 to 2010, they found that TNFi prescribing increased by 156% per year -- from 2389 units in 2000 to 116,747 in 2010. After data analysis, the increase in TNFi prescribing was found to coincide with a decrease in RA inpatient days for any reason: 49,000 annually pre-2002, reducing by 13% thereafter to 31,000 annually in 2010 (-0.78, P=0.0055). That likely contributed significantly to savings of approximately €16,000,000 annually based on current inpatient hospital data, the researchers noted. 

   Additionally, 550 annual MSKSPs were recorded on RA inpatients pre-2002 with a subsequent reduction of 10% annually to 291 in 2010 (overall 47% decrease) and correlating significantly but negatively with the number of TNFi prescriptions (-0.96, P <0.0001). 

   According to the researchers, “factors other than TNFi usage, such as improved use of non-biologic disease-modifying treatments and prevention of comorbidities, may also have contributed to these improved patient outcomes. Further analysis of these data including the economic impact is underway.”