Cost-effectiveness of the early arthritis clinic organizational model: the ELECTRA study

Objective: Early diagnosis and tight control improve outcomes of rheumatoid arthritis (RA). However, it is not known whether establishing an Early Arthritis Clinic (EAC) is sustainable for national health systems. This analysis aims to compare effectiveness and costs of an EAC compared to patients followed as for standards of care. Methods: A retrospective study on administrative health databases of patients with a new diagnosis of RA was conducted: 430 patients followed in an EAC were enrolled, and 4 non-EAC controls were randomly matched for each of them. During two years of follow up, the mean healthcare costs (outpatient, inpatient, pharmaceutical and global) and 3 effectiveness measures (number and length of hospitalization and quality of care) of EAC and non-EAC were estimated. The incremental cost-effectiveness ratio was calculated as well as the cost-effectiveness acceptability curve. Results: The cohorts included patients with a mean age of 55.4 years and 1506 (70%) females. Mean pharmaceutical (2602 versus 1945 €) and outpatient (2447 versus 1778 €) costs were higher in the EAC cohort. Conversely, a higher rate of non-EAC patients had a low adherence to quality-of-care indicators. The expected number of hospitalizations and the length of stay were statistically significant higher in non-EAC versus EAC. Conclusion: Despite an expected increase in outpatient costs (visits and diagnostic tests) and pharmaceutical costs, the reduction in terms of number and length of hospitalizations and the higher adherence to international quality of care guidelines support the effectiveness of the EAC model.