Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis
Background: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA fr...
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2021
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REDICUC - Repositorio Universidad de La Costa |
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ftunivcosta |
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English |
topic |
cost-savings diagnosis imaging seronegative rheumatoid arthritis |
spellingShingle |
cost-savings diagnosis imaging seronegative rheumatoid arthritis Santos-Moreno, Pedro Alvis-Zakzuk, Nelson J Castillo, Edwin Villarreal, Laura Pineda, Carlos Sandoval, Hugo Valencia, Omaira Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis |
topic_facet |
cost-savings diagnosis imaging seronegative rheumatoid arthritis |
description |
Background: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA from everyday clinical practice. Methods: We performed a retrospective analysis for patients with presumptive SRA who tested negative for both rheumatoid factor and anti-cyclic citrullinated peptide antibodies, through an ADP imaging-based, that is a standard clinical practice in our center. After we confirmed the diagnosis of SRA or reclassified patients in terms of another proper diagnosis, we estimate direct costs in two scenarios: a conventional and ADP. We compared the cost of RA treatment during the first year against the cost of the most misdiagnosed treatment (osteoarthritis) found after applying the ADP to determine potential cost-savings. Results: We included 440 patients with a presumptive diagnosis of SRA. According to the imaging-based ADP, SRA was confirmed in 106/440 (24.1%), unspecified RA in 9/440 (2.0%), and osteoarthritis in 325/440 (73.9%) of those patients. Although the costs of conventional diagnosis per patient is lower than those of ADP ($59,20 USD vs $269,57 USD), we found a potential drug cost-savings of $1,570,775.20 US Dollars after 1 year of correct treatment. Conclusion: An alternative diagnosis process, including X-rays, US and MRI imaging, and clinical and blood-test assessment, not only increased diagnostic certainty in patients referred for evaluation of presumptive SRA but also suggested a potential cost-savings in pharmacological treatments avoided in misdiagnosed patients. |
format |
Article in Journal/Newspaper |
author |
Santos-Moreno, Pedro Alvis-Zakzuk, Nelson J Castillo, Edwin Villarreal, Laura Pineda, Carlos Sandoval, Hugo Valencia, Omaira |
author_facet |
Santos-Moreno, Pedro Alvis-Zakzuk, Nelson J Castillo, Edwin Villarreal, Laura Pineda, Carlos Sandoval, Hugo Valencia, Omaira |
author_sort |
Santos-Moreno, Pedro |
title |
Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis |
title_short |
Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis |
title_full |
Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis |
title_fullStr |
Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis |
title_full_unstemmed |
Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis |
title_sort |
quantifying potential cost-savings through an alternative imaging-based diagnostic process in presumptive seronegative rheumatoid arthritis |
publishDate |
2021 |
url |
https://hdl.handle.net/11323/8624 https://doi.org/10.2147/CEOR.S302404 https://repositorio.cuc.edu.co/ |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
ClinicoEconomics and Outcomes Research https://pubmed.ncbi.nlm.nih.gov/34168469/ |
op_relation |
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–2581. doi:10.1002/art.27584 Nordberg LB, Lillegraven S, Aga AB, et al. Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial. RMD Open. 2018;4(2):e000752. doi:10.1136/rmdopen-2018-000752 Ostergaard M, Pedersen SJ, Dohn UM. Imaging in rheumatoid arthritis- status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol. 2008;22(6):1019–1044. doi:10.1016/j.berh.2008.09.014 Pratt AG, Isaacs JD. Seronegative rheumatoid arthritis: pathogenetic and therapeutic aspects. Best Pract Res Clin Rheumatol. 2014;28(4):651–659. doi:10.1016/j.berh.2014.10.016 Vasanth LC, Pavlov H, Bykerk V. Imaging of rheumatoid arthritis. Rheum Dis Clin North Am. 2013;39(3):547–566. doi:10.1016/j.rdc.2013.03.007 Ostergaard M, Peterfy CG, Bird P, et al. The OMERACT rheumatoid arthritis magnetic resonance imaging (MRI) scoring system: updated recommendations by the OMERACT MRI in arthritis working group. J Rheumatol. 2017;44(11):1706–1712. doi:10.3899/jrheum.161433 Szkudlarek M, Terslev L, Wakefield RJ, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol. 2016;43(1):12–21. doi:10.3899/jrheum.141416 Ostergaard M, Ejbjerg B, Szkudlarek M. Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultrasonography, conventional radiography and computed tomography. Best Pract Res Clin Rheumatol. 2005;19(1):91–116. doi:10.1016/j.berh.2004.08.006 Rudwaleit M, van der Heijde D, Landewe R, et al. The development of assessment of spondyloarthritis international society slassification criteria for axial spondyloarthritis (Part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–783. doi:10.1136/ard.2009.108233 Aringer M, Costenbader K, Daikh D, et al. 2019 European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151–1159. doi:10.1136/annrheumdis-2018-214819 Shiboski CH, Shiboski SC, Seror R, et al. 2016 American college of rheumatology/European league against rheumatism classification criteria for primary Sjogren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9–16. doi:10.1136/annrheumdis-2016-210571 Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–2487. Terslev L, Naredo E, Aegerter P, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce- part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open. 2017;3(1):e000427. doi:10.1136/rmdopen-2016-000427 Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(4):955–962. doi:10.1002/art.10877 England BR, Tiong BK, Bergman MJ, et al. 2019 Update of the American college of rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res. 2019;71(12):1540–1555. doi:10.1002/acr.24042 Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–977. doi:10.1136/annrheumdis-2016-210715 Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–474. doi:10.1002/acr.21596 Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251–1260. doi:10.1136/annrheumdis-2018-213585 Instituto de Evaluación Tecnológica en Salud. Manual para la elaboración de evaluaciones económicas en salud. Bogotá, D.C: IETS; 2014. Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Int J Technol Assess Health Care. 2013;29(2):117–122. doi:10.1017/s0266462313000160 Minsalud. SISMED - Sistema de Información de Precios de Medicamentos Ministerio Colombiano de Salud y Protección Social. 2019. Available from: https://www.sispro.gov.co/central-prestadores-de-servicios/Pages/SISMED-. Accessed July8, 2019. Miles KA. Cancer imaging: is it cost-effective? Cancer Imaging. 2004;4(2):97–103. doi:10.1102/1470-7330.2004.0017 Rezaei H, Torp-Pedersen S, Af Klint E, et al. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis- a probabilistic approach. Arthritis Res Ther. 2014;16(5):448. doi:10.1186/s13075-014-0448-6 Jeka S, Dura M, Zuchowski P, Zwierko B, Waszczak-Jeka M. The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy. Adv Clinical Exp Med. 2018;27(9):1303–1307. doi:10.17219/acem/69133 Colebatch AN, Edwards CJ, Ostergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804–814. doi:10.1136/annrheumdis-2012-203158 Ventura-Ríos L, Hernández-Díaz C, Sánchez-Bringas G, Madrigal-Santillán E, Morales-González JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol. 2016;35(9):2269–2276. doi:10.1007/s10067-016-3338-2 Sahatciu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Radiographic estimation in seropositive and seronegative rheumatoid arthritis. Bosn J Basic Med Sci. 2011;11(3):180–184. doi:10.17305/bjbms.2011.2571 Chan KW, Felson DT, Yood RA, Walker AM. The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. Arthritis Rheum. 1994;37(6):814–820. doi:10.1002/art.1780370606 Bird P, Conaghan P, Ejbjerg B, et al. The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis. 2005;64(Suppl 1):i8–i10. doi:10.1136/ard.2004.031807 Duer-Jensen A, Horslev-Petersen K, Hetland ML, et al. Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis. Arthritis Rheum. 2011;63(8):2192–2202. doi:10.1002/art.30396 Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology. 2000;216(2):569–575. doi:10.1148/radiology.216.2.r00au20569 Nieuwenhuis WP, Krabben A, Stomp W, et al. Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 2015;67(4):869–876. doi:10.1002/art.39000 Machado PM, Koevoets R, Bombardier C, van der Heijde DM. The value of magnetic resonance imaging and ultrasound in undifferentiated arthritis: a systematic review. J Rheumatol. 2011;87:31–37. doi:10.3899/jrheum.101072 Narváez J, Sirvent E, Narváez JA, et al. Usefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosions. Semin Arthritis Rheum. 2008;38(2):101–109. doi:10.1016/j.semarthrit.2007.10.012 Buisman LR, Luime JJ, Oppe M, Hazes JMW, Rutten-van Molken MP. A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis. Arthritis Res Ther. 2016;18(1):135. doi:10.1186/s13075-016-1020-3 https://hdl.handle.net/11323/8624 https://doi.org/10.2147/CEOR.S302404 Corporación Universidad de la Costa REDICUC - Repositorio CUC https://repositorio.cuc.edu.co/ |
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Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess http://purl.org/coar/access_right/c_abf2 |
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ftunivcosta:oai:repositorio.cuc.edu.co:11323/8624 2024-01-14T10:03:20+01:00 Quantifying Potential Cost-Savings Through an Alternative Imaging-Based Diagnostic Process in Presumptive Seronegative Rheumatoid Arthritis Santos-Moreno, Pedro Alvis-Zakzuk, Nelson J Castillo, Edwin Villarreal, Laura Pineda, Carlos Sandoval, Hugo Valencia, Omaira 2021 application/pdf https://hdl.handle.net/11323/8624 https://doi.org/10.2147/CEOR.S302404 https://repositorio.cuc.edu.co/ eng eng Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569–2581. doi:10.1002/art.27584 Nordberg LB, Lillegraven S, Aga AB, et al. Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial. RMD Open. 2018;4(2):e000752. doi:10.1136/rmdopen-2018-000752 Ostergaard M, Pedersen SJ, Dohn UM. Imaging in rheumatoid arthritis- status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol. 2008;22(6):1019–1044. doi:10.1016/j.berh.2008.09.014 Pratt AG, Isaacs JD. Seronegative rheumatoid arthritis: pathogenetic and therapeutic aspects. Best Pract Res Clin Rheumatol. 2014;28(4):651–659. doi:10.1016/j.berh.2014.10.016 Vasanth LC, Pavlov H, Bykerk V. Imaging of rheumatoid arthritis. Rheum Dis Clin North Am. 2013;39(3):547–566. doi:10.1016/j.rdc.2013.03.007 Ostergaard M, Peterfy CG, Bird P, et al. The OMERACT rheumatoid arthritis magnetic resonance imaging (MRI) scoring system: updated recommendations by the OMERACT MRI in arthritis working group. J Rheumatol. 2017;44(11):1706–1712. doi:10.3899/jrheum.161433 Szkudlarek M, Terslev L, Wakefield RJ, et al. Summary findings of a systematic literature review of the ultrasound assessment of bone erosions in rheumatoid arthritis. J Rheumatol. 2016;43(1):12–21. doi:10.3899/jrheum.141416 Ostergaard M, Ejbjerg B, Szkudlarek M. Imaging in early rheumatoid arthritis: roles of magnetic resonance imaging, ultrasonography, conventional radiography and computed tomography. Best Pract Res Clin Rheumatol. 2005;19(1):91–116. doi:10.1016/j.berh.2004.08.006 Rudwaleit M, van der Heijde D, Landewe R, et al. The development of assessment of spondyloarthritis international society slassification criteria for axial spondyloarthritis (Part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–783. doi:10.1136/ard.2009.108233 Aringer M, Costenbader K, Daikh D, et al. 2019 European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151–1159. doi:10.1136/annrheumdis-2018-214819 Shiboski CH, Shiboski SC, Seror R, et al. 2016 American college of rheumatology/European league against rheumatism classification criteria for primary Sjogren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9–16. doi:10.1136/annrheumdis-2016-210571 Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–2487. Terslev L, Naredo E, Aegerter P, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce- part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open. 2017;3(1):e000427. doi:10.1136/rmdopen-2016-000427 Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Ostergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003;48(4):955–962. doi:10.1002/art.10877 England BR, Tiong BK, Bergman MJ, et al. 2019 Update of the American college of rheumatology recommended rheumatoid arthritis disease activity measures. Arthritis Care Res. 2019;71(12):1540–1555. doi:10.1002/acr.24042 Smolen JS, Landewe R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76(6):960–977. doi:10.1136/annrheumdis-2016-210715 Hochberg MC, Altman RD, April KT, et al. American college of rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–474. doi:10.1002/acr.21596 Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018;77(9):1251–1260. doi:10.1136/annrheumdis-2018-213585 Instituto de Evaluación Tecnológica en Salud. Manual para la elaboración de evaluaciones económicas en salud. Bogotá, D.C: IETS; 2014. Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Int J Technol Assess Health Care. 2013;29(2):117–122. doi:10.1017/s0266462313000160 Minsalud. SISMED - Sistema de Información de Precios de Medicamentos Ministerio Colombiano de Salud y Protección Social. 2019. Available from: https://www.sispro.gov.co/central-prestadores-de-servicios/Pages/SISMED-. Accessed July8, 2019. Miles KA. Cancer imaging: is it cost-effective? Cancer Imaging. 2004;4(2):97–103. doi:10.1102/1470-7330.2004.0017 Rezaei H, Torp-Pedersen S, Af Klint E, et al. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis- a probabilistic approach. Arthritis Res Ther. 2014;16(5):448. doi:10.1186/s13075-014-0448-6 Jeka S, Dura M, Zuchowski P, Zwierko B, Waszczak-Jeka M. The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy. Adv Clinical Exp Med. 2018;27(9):1303–1307. doi:10.17219/acem/69133 Colebatch AN, Edwards CJ, Ostergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72(6):804–814. doi:10.1136/annrheumdis-2012-203158 Ventura-Ríos L, Hernández-Díaz C, Sánchez-Bringas G, Madrigal-Santillán E, Morales-González JA, Pineda C. A descriptive, cross-sectional study characterizing bone erosions in rheumatoid arthritis and gout by ultrasound. Clin Rheumatol. 2016;35(9):2269–2276. doi:10.1007/s10067-016-3338-2 Sahatciu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Radiographic estimation in seropositive and seronegative rheumatoid arthritis. Bosn J Basic Med Sci. 2011;11(3):180–184. doi:10.17305/bjbms.2011.2571 Chan KW, Felson DT, Yood RA, Walker AM. The lag time between onset of symptoms and diagnosis of rheumatoid arthritis. Arthritis Rheum. 1994;37(6):814–820. doi:10.1002/art.1780370606 Bird P, Conaghan P, Ejbjerg B, et al. The development of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis. 2005;64(Suppl 1):i8–i10. doi:10.1136/ard.2004.031807 Duer-Jensen A, Horslev-Petersen K, Hetland ML, et al. Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis. Arthritis Rheum. 2011;63(8):2192–2202. doi:10.1002/art.30396 Sugimoto H, Takeda A, Hyodoh K. Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for diagnosis. Radiology. 2000;216(2):569–575. doi:10.1148/radiology.216.2.r00au20569 Nieuwenhuis WP, Krabben A, Stomp W, et al. Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 2015;67(4):869–876. doi:10.1002/art.39000 Machado PM, Koevoets R, Bombardier C, van der Heijde DM. The value of magnetic resonance imaging and ultrasound in undifferentiated arthritis: a systematic review. J Rheumatol. 2011;87:31–37. doi:10.3899/jrheum.101072 Narváez J, Sirvent E, Narváez JA, et al. Usefulness of magnetic resonance imaging of the hand versus anticyclic citrullinated peptide antibody testing to confirm the diagnosis of clinically suspected early rheumatoid arthritis in the absence of rheumatoid factor and radiographic erosions. Semin Arthritis Rheum. 2008;38(2):101–109. doi:10.1016/j.semarthrit.2007.10.012 Buisman LR, Luime JJ, Oppe M, Hazes JMW, Rutten-van Molken MP. A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis. Arthritis Res Ther. 2016;18(1):135. doi:10.1186/s13075-016-1020-3 https://hdl.handle.net/11323/8624 https://doi.org/10.2147/CEOR.S302404 Corporación Universidad de la Costa REDICUC - Repositorio CUC https://repositorio.cuc.edu.co/ Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess http://purl.org/coar/access_right/c_abf2 ClinicoEconomics and Outcomes Research https://pubmed.ncbi.nlm.nih.gov/34168469/ cost-savings diagnosis imaging seronegative rheumatoid arthritis Artículo de revista http://purl.org/coar/resource_type/c_6501 Text info:eu-repo/semantics/article http://purl.org/redcol/resource_type/ART info:eu-repo/semantics/acceptedVersion http://purl.org/coar/version/c_ab4af688f83e57aa 2021 ftunivcosta https://doi.org/10.2147/CEOR.S30240410.1002/art.2758410.1136/rmdopen-2018-00075210.1016/j.berh.2008.09.01410.1016/j.berh.2014.10.01610.1016/j.rdc.2013.03.00710.3899/jrheum.16143310.3899/jrheum.14141610.1016/j.berh.2004.08.00610.1136/ard.2009.10823310.1136 2023-12-17T19:23:41Z Background: Seronegative rheumatoid arthritis (SRA) is a condition that is not well understood and difficult to confirm by a conventional diagnostic process. We aimed to quantify the potential cost-savings of an alternative diagnostic process (ADP) imaging-based, for patients with presumptive SRA from everyday clinical practice. Methods: We performed a retrospective analysis for patients with presumptive SRA who tested negative for both rheumatoid factor and anti-cyclic citrullinated peptide antibodies, through an ADP imaging-based, that is a standard clinical practice in our center. After we confirmed the diagnosis of SRA or reclassified patients in terms of another proper diagnosis, we estimate direct costs in two scenarios: a conventional and ADP. We compared the cost of RA treatment during the first year against the cost of the most misdiagnosed treatment (osteoarthritis) found after applying the ADP to determine potential cost-savings. Results: We included 440 patients with a presumptive diagnosis of SRA. According to the imaging-based ADP, SRA was confirmed in 106/440 (24.1%), unspecified RA in 9/440 (2.0%), and osteoarthritis in 325/440 (73.9%) of those patients. Although the costs of conventional diagnosis per patient is lower than those of ADP ($59,20 USD vs $269,57 USD), we found a potential drug cost-savings of $1,570,775.20 US Dollars after 1 year of correct treatment. Conclusion: An alternative diagnosis process, including X-rays, US and MRI imaging, and clinical and blood-test assessment, not only increased diagnostic certainty in patients referred for evaluation of presumptive SRA but also suggested a potential cost-savings in pharmacological treatments avoided in misdiagnosed patients. Article in Journal/Newspaper Arctic REDICUC - Repositorio Universidad de La Costa Sensors 13 4 5338 5346 |