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

Samuel Hawley; René Cordtz; Lene Dreyer; Christopher J Edwards; Nigel K Arden; Antonella Delmestri; Alan Silman; Cyrus Cooper; Andrew Judge; Daniel Prieto-Alhambra

doi:10.1016/j.semarthrit.2017.09.006

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

Samuel Hawley, René Cordtz, Lene Dreyer, Christopher J Edwards, Nigel K Arden, Antonella Delmestri, Alan Silman, Cyrus Cooper, Andrew Judge, Daniel Prieto-Alhambra

Department of Clinical Medicine

10 Citations (Scopus)

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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.

Original language	English
Journal	Seminars in Arthritis and Rheumatism
Volume	47
Issue number	5
Pages (from-to)	605-610
ISSN	0049-0172
DOIs	https://doi.org/10.1016/j.semarthrit.2017.09.006
Publication status	Published - Apr 2018

Keywords

Antirheumatic Agents/therapeutic use
Arthritis, Rheumatoid/drug therapy
Arthroplasty, Replacement, Hip/statistics & numerical data
Arthroplasty, Replacement, Knee/statistics & numerical data
Biological Products/therapeutic use
England
Female
Humans
Male
Middle Aged
Wales

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Hawley, S., Cordtz, R., Dreyer, L., Edwards, C. J., Arden, N. K., Delmestri, A., Silman, A., Cooper, C., Judge, A., & Prieto-Alhambra, D. (2018). Association between NICE guidance on biologic 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, 47(5), 605-610. https://doi.org/10.1016/j.semarthrit.2017.09.006

Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales : An interrupted time-series analysis. / Hawley, Samuel; Cordtz, René; Dreyer, Lene et al.

In: Seminars in Arthritis and Rheumatism, Vol. 47, No. 5, 04.2018, p. 605-610.

Research output: Contribution to journal › Journal article › Research › peer-review

Hawley, S, Cordtz, R, Dreyer, L, Edwards, CJ, Arden, NK, Delmestri, A, Silman, A, Cooper, C, Judge, A & Prieto-Alhambra, D 2018, 'Association between NICE guidance on biologic 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, vol. 47, no. 5, pp. 605-610. https://doi.org/10.1016/j.semarthrit.2017.09.006

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title = "Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales: An interrupted time-series analysis",

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.",

keywords = "Antirheumatic Agents/therapeutic use, Arthritis, Rheumatoid/drug therapy, Arthroplasty, Replacement, Hip/statistics & numerical data, Arthroplasty, Replacement, Knee/statistics & numerical data, Biological Products/therapeutic use, England, Female, Humans, Male, Middle Aged, Wales",

author = "Samuel Hawley and Ren{\'e} Cordtz and Lene Dreyer and Edwards, {Christopher J} and Arden, {Nigel K} and Antonella Delmestri and Alan Silman and Cyrus Cooper and Andrew Judge and Daniel Prieto-Alhambra",

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doi = "10.1016/j.semarthrit.2017.09.006",

language = "English",

volume = "47",

pages = "605--610",

journal = "Seminars in Arthritis and Rheumatism",

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T1 - Association between NICE guidance on biologic therapies with rates of hip and knee replacement among rheumatoid arthritis patients in England and Wales

T2 - An interrupted time-series analysis

AU - Hawley, Samuel

AU - Cordtz, René

AU - Dreyer, Lene

AU - Edwards, Christopher J

AU - Arden, Nigel K

AU - Delmestri, Antonella

AU - Silman, Alan

AU - Cooper, Cyrus

AU - Judge, Andrew

AU - Prieto-Alhambra, Daniel

PY - 2018/4

Y1 - 2018/4

N2 - 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.

AB - 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.

KW - Antirheumatic Agents/therapeutic use

KW - Arthritis, Rheumatoid/drug therapy

KW - Arthroplasty, Replacement, Hip/statistics & numerical data

KW - Arthroplasty, Replacement, Knee/statistics & numerical data

KW - Biological Products/therapeutic use

KW - England

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Wales

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DO - 10.1016/j.semarthrit.2017.09.006

M3 - Journal article

C2 - 29055489

SN - 0049-0172

VL - 47

SP - 605

EP - 610

JO - Seminars in Arthritis and Rheumatism

JF - Seminars in Arthritis and Rheumatism

IS - 5

ER -

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

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Keywords

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