[Cost of illness in axial spondylarthritis for patients with and without tumor necrosis factor inhibitor treatment: results of a routine data analysis]. / Krankheitskosten bei axialer Spondyloarthritis für Patienten mit und ohne Tumor-Nekrose-Faktor-Inhibitor-Behandlung: Ergebnisse einer Routinedatenanalyse.

BACKGROUND: Tumour necrosis factor-alpha inhibitors (TNFi) are an effective but expensive treatment option in axial spondylarthritis (axSpA) patients who fail to achieve disease control under conventional treatment. OBJECTIVE: The aim of this study was to assess the cost of illness in axSpA patients treated with and without TNFi. METHODS: Using German health insurance data, patients with axSpA who newly received TNFi between 2011 and 2015 were identified and matched by age and sex to a reference group of patients with axSpA without TNFi treatment. Costs for services performed in an outpatient setting, inpatient care, pharmacotherapy and for productivity loss due to absence from paid work were analyzed over a 2-year period. In patients treated with TNFi , the 2­year period included 1 year before and 1 year after the initiation of TNFi. RESULTS: Data from 1455 axSpA patients who received TNFi treatment were included in the analyses. Costs for services performed in an outpatient setting, inpatient care, pharmacotherapy (excluding TNFi) as well as productivity loss significantly decreased after initiation of TNFi. Mean total costs increased from €â€¯6075 in the year prior to TNFi initiation to €â€¯27,871 in the year after TNFi initiation. Excluding costs for TNFi, total costs decreased by 22% to €â€¯4761. Mean total costs among the reference group of 1455 age and sex-matched axSpA patients who did not receive TNFi remained stable over 2 years: €â€¯3939 in the first year vs. €â€¯3832 in the second year. CONCLUSION: Initiation of TNFi treatment led to a sharp increase in the total costs of axSpA patients. Part of this increase was offset by a decrease of costs for services performed in an outpatient setting, inpatient care, pharmacotherapy (excluding TNFi) as well as productivity loss. In patients who did not receive TNFi, the costs remained stable over 2 years.

[Perspectives for rheumatological health services research at the German Rheumatism Research Center]. / Perspektiven für die rheumatologische Versorgungsforschung am Deutschen Rheuma-Forschungszentrum.

This review article summarizes the current projects and perspectives of rheumatological healthcare research in the program area epidemiology of the German Rheumatism Research Center. Health services research is conducted with the help of various data sources. In addition to the classical rheumatological disease registers, health insurance data and population-related cohorts are increasingly being used for analyses. From data collection and monitoring to analysis algorithms, digital applications will change the healthcare research over the coming years. Collaborative analyses with national and international cooperation partners, including biomarkers, complete the research fields in the program area epidemiology. The digitalization of research projects is a central component that will further change health services research in the coming decade.

[Health care and disease burden in persons with axial spondyloarthritis in Germany]. / Gesundheitsversorgung und Krankheitslast bei Personen mit axialer Spondyloarthritis in Deutschland.

BACKGROUND: Only very few data are available on the comprehensive care in patients with axial spondylarthritis (axSpA), one of the most frequent inflammatory rheumatic disease. OBJECTIVE: Description of the comprehensive care and common prescription patterns of medications and other therapies in patients with axSpA depending on the type of medical care by rheumatologists or nonrheumatologists. METHODS: A cross-sectional analysis was performed based on claims data of the BARMER health insurance company (in 2015) and a questionnaire, which was sent to a representative sample of patients with axSpA (International Classification of Diseases, 10th revision, German modification, ICD-10-GM, code M45) aged 18-79 years. A stratified sample of 5000 patients was used. The patients received a postal questionnaire including questions regarding the disease, health-related and psychological parameters and socioeconomic factors. Claims data consisted of demographic factors, medicinal and nonmedicinal treatment and the extra-articular manifestations inflammatory bowel disease, psoriasis and uveitis. RESULTS: A total of 1741 patients (mean age 55.9 years, female 46.4%, 86.2% Human Leucocyte Antigen[HLA]-B27 positive) confirmed the diagnosis and answered the questionnaire. The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.5 and the mean Bath Ankylosing Spondylitis Functional Index (BASFI) 4.1. Of the patients 46% were treated by rheumatologists. There was a substantial difference between patients in rheumatological care and those who were not in rheumatological care regarding prescriptions for drug treatment of axSpA (91.8% versus 66.4%). This difference was especially prominent for prescriptions of biologic disease-modifying antirheumatic drugs: 34.1% of patients in rheumatological care versus 3.1% of patients treated by nonrheumatologists (p < 0.0001), despite similar disease activity in both groups. CONCLUSION: The data show that the majority of patients diagnosed with axSpA did not receive regular care from rheumatologists. This seemed to be associated with insufficient medicinal care at least in some of these patients.

Which Magnetic Resonance Imaging Lesions in the Sacroiliac Joints Are Most Relevant for Diagnosing Axial Spondyloarthritis? A Prospective Study Comparing Rheumatologists' Evaluations With Radiologists' Findings.

OBJECTIVE: Pathologic sacroiliac (SI) joint changes on magnetic resonance imaging (MRI) are important for the classification of axial spondyloarthritis (SpA). In daily practice, radiologists play a major role in interpreting imaging findings. This study was undertaken to evaluate the impact of MRI SI joint findings on the identification of axial SpA by radiologists, in comparison to diagnosis by rheumatologists. METHODS: Patients age ≤45 years were prospectively included when referred for clinical suspicion of axial SpA and underwent a complete diagnostic evaluation including STIR- and T1-weighted MRI of the SI joint. Diagnosis made by an experienced rheumatologist with access to all relevant information was considered the gold standard. MRIs were evaluated by 2 experienced radiologists who were unaware of the clinical data, who indicated which MRI lesions were "critical" to the decision for or against axial SpA. RESULTS: Of the 300 patients included, 132 (44%) were diagnosed as having axial SpA. Mean age was comparable between the 2 groups, but patients with axial SpA and those with non-axial SpA differed with regard to symptom duration (58.6 ± 69.5 versus 33.9 ± 45.1 months, respectively; P = 0.003) and HLA-B27 positivity (75.6% versus 19%, respectively; P < 0.001). Rheumatologists and radiologists agreed on the diagnosis in 262 cases (87.3%), while 34 patients (11.3%) were diagnosed as having axial SpA by rheumatologists only (clinically), and 4 cases (1.3%) were judged as suggestive of axial SpA by radiologists only. Bone marrow edema (BME) and sclerosis showed the highest sensitivity, while erosions and fatty lesions showed the highest specificity, for axial SpA diagnosis. The combination of BME with erosions had the highest positive predictive value (86.5%). CONCLUSION: The MRI findings with the highest diagnostic value in patients in whom axial SpA is suspected are structural changes in the SI joint, alone or in combination with BME. Our findings indicate that while the absence of BME is usually not compatible with a diagnosis of axial SpA, the presence of BME does not necessarily confirm a diagnosis of axial SpA.