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Association between NICE guidance on biological therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: an interrupted time-series analysis

Association between NICE guidance on biological therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: an interrupted time-series analysis
Association between NICE guidance on biological therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: an interrupted time-series analysis
Objective: to estimate the impact of NICE approval of tumor necrosis factor inhibitor (TNFi) therapies on the incidence of total hip replacement (THR) and total knee replacement (TKR) among rheumatoid arthritis (RA) patients in England and Wales.

Methods: primary care data [Clinical Practice Research Datalink (CPRD)] for the study period (1995–2014) were used to identify incident adult RA patients. The age and sex-standardised 5-year incidence of THR and TKR was calculated separately for RA patients diagnosed in each six-months between 1995–2009. We took a natural experimental approach, using segmented linear regression to estimate changes in level and trend following the publication of NICE TA 36 in March 2002, incorporating a 1-year lag. Regression coefficients were used to calculate average change in rates, adjusted for prior level and trend.

Results: we identified 17,505 incident RA patients of whom 465 and 650 underwent THR and TKR surgery, respectively. The modeled average incidence of THR and TKR over the biologic-era was 6.57/1000 person years (PYs) and 8.51/1000 PYs, respectively, with projected (had pre-NICE TA 36 level and trend continued uninterrupted) figures of 5.63/1000 PYs and 12.92 PYs, respectively. NICE guidance was associated with a significant average decrease in TKR incidence of −4.41/1000 PYs (95% C.I. −6.88 to −1.94), equating to a relative 34% reduction. Overall, no effect was seen on THR rates.

Conclusions: among incident RA patients in England and Wales, NICE guidance on TNFi therapies for RA management was temporally associated with reduced rates of TKR but not THR.
0049-0172
Hawley, Samuel
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Cordtz, Rene
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Dreyer, Lene
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Edwards, Christopher J.
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Arden, Nigel
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Delmestri, Antonella
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Silman, Alan J.
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Cooper, Cyrus
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Judge, Andrew
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Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Cordtz, Rene
10518317-7fad-4d02-b546-88f77c4c9154
Dreyer, Lene
9fd5a36c-1d7d-4171-ba4e-fc19cd420677
Edwards, Christopher J.
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Arden, Nigel
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Delmestri, Antonella
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Silman, Alan J.
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Cooper, Cyrus
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Judge, Andrew
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Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9

Hawley, Samuel, Cordtz, Rene, Dreyer, Lene, Edwards, Christopher J., Arden, Nigel, Delmestri, Antonella, Silman, Alan J., Cooper, Cyrus, Judge, Andrew and Prieto-Alhambra, Daniel (2017) Association between NICE guidance on biological therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: an interrupted time-series analysis. Seminars in Arthritis and Rheumatism. (doi:10.1016/j.semarthrit.2017.09.006).

Record type: Article

Abstract

Objective: to estimate the impact of NICE approval of tumor necrosis factor inhibitor (TNFi) therapies on the incidence of total hip replacement (THR) and total knee replacement (TKR) among rheumatoid arthritis (RA) patients in England and Wales.

Methods: primary care data [Clinical Practice Research Datalink (CPRD)] for the study period (1995–2014) were used to identify incident adult RA patients. The age and sex-standardised 5-year incidence of THR and TKR was calculated separately for RA patients diagnosed in each six-months between 1995–2009. We took a natural experimental approach, using segmented linear regression to estimate changes in level and trend following the publication of NICE TA 36 in March 2002, incorporating a 1-year lag. Regression coefficients were used to calculate average change in rates, adjusted for prior level and trend.

Results: we identified 17,505 incident RA patients of whom 465 and 650 underwent THR and TKR surgery, respectively. The modeled average incidence of THR and TKR over the biologic-era was 6.57/1000 person years (PYs) and 8.51/1000 PYs, respectively, with projected (had pre-NICE TA 36 level and trend continued uninterrupted) figures of 5.63/1000 PYs and 12.92 PYs, respectively. NICE guidance was associated with a significant average decrease in TKR incidence of −4.41/1000 PYs (95% C.I. −6.88 to −1.94), equating to a relative 34% reduction. Overall, no effect was seen on THR rates.

Conclusions: among incident RA patients in England and Wales, NICE guidance on TNFi therapies for RA management was temporally associated with reduced rates of TKR but not THR.

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Accepted/In Press date: 22 September 2017
e-pub ahead of print date: 23 October 2017

Identifiers

Local EPrints ID: 415185
URI: http://eprints.soton.ac.uk/id/eprint/415185
ISSN: 0049-0172
PURE UUID: ac678756-8909-4412-bdaf-f2ef9604cdb0
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 02 Nov 2017 17:30
Last modified: 18 Mar 2024 02:46

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Contributors

Author: Samuel Hawley
Author: Rene Cordtz
Author: Lene Dreyer
Author: Christopher J. Edwards
Author: Nigel Arden
Author: Antonella Delmestri
Author: Alan J. Silman
Author: Cyrus Cooper ORCID iD
Author: Andrew Judge
Author: Daniel Prieto-Alhambra

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