Algorithmic Screening for Axial Spondyloarthritis – Efficacy and Health Economic Analysis Cost-Effective Screening for Early Axial Spondyloarthritis

Edit Vereckei, Dorottya Nagy D and László Hodinka*

Received: May 12, 2018;   Published: May 22, 2018

DOI: 10.26717/BJSTR.2018.04.001098

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Abstract

Background: Spondyloarthritis is a non-infectious autoinflammatory disease affecting the spine, peripheral joints and may be asociated with skin, enteral and eye manifestations. Progressive vertebral inflammation is dominant in this heterogeneous clinical picture which develops with different frequency and severity in genetically predisposed persons expressing the HLA B27 histocompatibilty antigen. Classical bone erosions and fusions can be demonstrated by X-ray, however in a longer latent clinical phase.The correct diagnosis and starting innovative biological treatment is crucial in prevention of the late changes, In order to avoid delay diagnostic criteria and screening tools have been developed for the early clinical phase defined as non-radiographic axial spondyloarthritis. In the hierarchy of screening steps the clinical signs, i.e typical inflammatory back pain and other manifestations are the basis rationally followed a traditional X-ray image of the sacroiliac joints and the HLA B27 typing is the rational sequence. However, according to an international multi-center surveypreference of MR imaging is common just in the screening phase.

Method: The aim of our study was the health economic analysis of screening non-radiographic axial spondylarthritis with the assumption that the cost of the proper diagnosis of a case is lower following the algorithmic sequence is lower compared to that on MRI basis. Simplified cost minimization, cost-effectivity and cost-utility calculations have been performed using case numbers of two published and our own patient populations.

Results and Conclusion: Moderate cost reductions as 209 or 503 euros savings and 103 Cost-Effectiveness Ratio (ICER) or cost-utility ratios may be achieved using the recommended algorithms.

Keywords: Axial Spondyloarthritis; Algorithmic Screening; Cost-Effectivity

Abbreviations: ASAS: Assessment of Spondylo Arthritis International Society; CRP: C-Reactive Protein; HLA B27: Histocompatibility Antigen B27; ICER: Incremental Cost Effectivity Ratio; IBD: Inflammatory Bowel Disease; MAXIMA: Management of Axial SpA International and Multicentric Approaches study; MRI: Magnetic Resonance Imaging; PAMP: Pathogen Associated Molecular Pattern; SPACE: SpondyloArthritis Caught Early study; TNF: Tumor Necrosis Factor

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