Please refer to the full Prescribing Information at CIMZIAhcp.com.
The impact of delayed diagnosis of nr-axSpA to payers and health systems can be substantial. However, given the long delay in diagnosis,1 patients may not be insured continuously by a single plan and they may lack longitudinal healthcare records to quantify the burden of their disease. In addition, undiagnosed or misdiagnosed patients may receive fragmented care from multiple physicians/specialties, receive misdiagnoses, and/or may not receive appropriate or effective therapies for nr-axSpA (Figure 11).2 In one study of a commercial claims database from 2012 to 2017 focusing upon patients with axSpA, including nr-axSpA (based upon diagnostic code 720.x), 27.3% of patients were classified as chronic opioid users.3,* Of those chronic opioid users, 43.3% were not receiving concomitant non-steroidal anti-inflammatory drugs (NSAIDs) or an anti-tumor necrosis factor (TNF) therapy, suggesting that they were using opioids exclusively to manage symptoms of their disease. As such, the underlying inflammation of their disease was not being addressed.3
A delay in diagnosis can mean that patients are continuing to experience disease activity, pain, and impairments in their function, quality of life (QoL), and work productivity. Additionally, a delay in diagnosis can lead to higher direct costs for care for specialists and pharmaceutical services.4
The current fee-for-service model for health care is evolving to a value-based care model in which providers are incentivized to deliver cost-effective and high-quality care.5 Partnership between the physicians and health plans is important to improve the delivery of care to these patients, avoid unnecessary costs, and minimize the impact of the disease.6
*Data included for all chronic opioid users (n = 21,590) in the 12-month follow-up period. Chronic opioid use defined as ≥90 cumulative days of opioid use. Concomitant medication use was defined as a claim made within ± 30 days of an opioid claim. Limitations of claims data include reliance on accurate diagnostic coding and exclusion of patients with commercial insurance. The indication for which opioids were prescribed, opioid potency and dosage were not included in the analysis. Use of over-the-counter NSAIDs was not captured. Additional limitations include broad ICD9 code (720.x) use which may result in the capture of other axial arthritic diseases and inclusion of false positive cases.
Figure 11. The nr-axSpA Patient Journey Is Long and May Involve Consultation With Many Healthcare Professionals, Misdiagnosis, and Inadequate Treatment1,2,7,8
ACR, American College of Rheumatology; CRP, C-reactive protein; HLA-B27, human leukocyte antigen B27; IBP, inflammatory back pain; MRI, magnetic resonance imaging; NSAIDs, non-steroidal anti-inflammatory drugs; SpA, spondyloarthritis; TNF, tumor necrosis factor.
1. Seo MR, Baek HL, Yoon HH, et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol. 2015;34(8):1397-1405.
2. UCB, Inc. Data on file.
3. Sloan VS, Sheahan A, Stark J, Suruki RY. Opioid Use in Patients with Ankylosing Spondylitis is Common in the United States: Outcomes of a Retrospective Cohort Study. J Rheumatol. 2019;46(4):1-30.
4. Mennini FS, et al. Economic evaluation of spondyloarthritis: economic impact of diagnostic delay in Italy. Clinicoecon Outcomes Res. 2018;10:45-51. doi: 10.2147/CEOR.S144209.
5. Burwell SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897-899.
6. CIO Review. Value-based healthcare models: now is the time. Available at: https://supply-chain.cioreview.com/cxoinsight/valuebased-healthcare-models-now-is-the-time-nid-25989-cid-78.html. Accessed April 10, 2019.
7. Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777-783.
8. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2016;68(2):282-298.
©2019 UCB, Inc., Smyrna, GA 30080. All rights reserved.
Version: August 2019
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