Tailored treatment can provide better health – and lower costs

A Norwegian study shows that more personalized treatment can provide better disease control. Now new analyses show that the healthcare system can also save money.

Caption: Silje Watterdal Syversen and Gunhild Hagen say that personalized treatment may require fewer resources.

The study examined how the dosage of the drug would affect each individual patient. The researchers found that patients experienced fewer periods of severe symptoms, known as flare-ups.

“It can give patients a more stable everyday life,” says Silje Watterdal Syversen. She is a rheumatologist at Diakonhjemmet Hospital.

“Without personalized adaptation, patients may experience more pain and poorer function. It can also lead to more sick leave,” she says.

Saves money per patient

Typically, patients receive a fixed dose of medication to maintain treatment. In this study, the researchers instead measured the level of the drug in the blood and adjusted the dose based on this.

The result is clear: This results in lower costs.

“We calculate that we can save 5,772 kroner per year per patient. This is mainly due to patients using less of the medicine,” says Gunhild Hagen. She is a health economist at the hospital.

The study shows that overall resource use was also lower, which may indicate a lower need for follow-up.

“If patients experience fewer flare-ups, the need to see a doctor may be reduced. This could provide more capacity in a pressured health service,” says Hagen.

Can save large sums of money overall

The researchers have investigated this in patients treated with infliximab. It is one of many drugs in a group called TNF inhibitors. These are used to treat various rheumatic diseases, intestinal diseases and skin diseases, among other things.

Over 50,000 Norwegians use such drugs if they have diseases such as spondyloarthritis, ulcerative colitis and psoriasis. TNF inhibitors are effective against inflammation, but are expensive. They can cost up to 100,000 kroner a year to treat a patient.

– Even small savings per patient can add up to large sums when many are treated, says Hagen.

More testing – but still profitable

Tailored treatment requires more blood tests, but the math still works out in the positive.

– The costs of additional testing are lower than what we save on medications and fewer flare-ups, says Hagen.

Less illness in everyday life

– However, the most important thing for patients is to control the disease, says Syversen.

The researchers also looked at quality of life. The results here are more uncertain because flare-ups are less frequent and short-lived in these patients. But one thing is clear: Flare-ups negatively impact life.

– When we manage to keep the disease more stable, it provides better opportunities to live a normal life, says Syversen.

Can change how patients are treated

The researchers believe these findings could help change the guidelines for how these patients should be treated.

“This is a step closer to more personalized treatment. We can use resources better and at the same time provide patients with a better service,” says Syversen.

The researchers emphasize that the results apply to the drug infliximab. It is not certain that this will apply in the same way to other TNF inhibitors.

This is now being tested further in a new study at the REMEDY Center. There, researchers are investigating whether they will find the same for the drug adalimumab. This is a European collaborative project funded by the EU.

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Facts:

The study referred to: Cost-effectiveness of proactive therapeutic drug monitoring of maintenance infliximab treatment in patients with immune-mediated inflammatory diseases: results from a randomized controlled trial 

The NORwegian DRUg Monitoring study, NOR-DRUM, is based at Diakonhjemmet Hospital and includes 21 hospitals. Rheumatologist Silje Watterdal Syversen is leading the project. Espen A. Haavardsholm is the principal investigator.

The economic analyses are led by health economist Gunhild Hagen at Diakonhjemmet Hospital.

TNF inhibitors are a group of drugs used to treat various chronic inflammatory diseases. Many people in Norway use such drugs if they have diseases such as arthritis, ulcerative colitis and psoriasis. TNF inhibitors are effective, but some of them are expensive and can cost hospitals up to 100,000 per patient per year.

NOR-DRUM is investigating the effect of tailored treatment with infliximab. The patients have chronic inflammatory diseases, such as various rheumatic diseases, intestinal diseases and skin diseases. More about NOR-DRUM