Economic Burden of Switching to a Non-Tumor Necrosis Factor Inhibitor Versus a Tumor Necrosis Factor Inhibitor Biologic Therapy among Patients with Rheumatoid Arthritis
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The objective of this study was to examine healthcare resource utilization (HRU) and costs associated with switching to another tumor necrosis factor alpha inhibitor (TNFi) therapy versus a non-TNFi therapy among patients with rheumatoid arthritis (RA) discontinuing use of an initial TNFi biologic therapy.
Patients with ≥2 RA diagnoses who used ≥1 TNFi on or after their initial RA diagnosis were identified in a US employer-based insurance claims database. Patients were selected based on ≥1 claim of another TNFi or a non-TNFi biologic therapy (occurring after 2010, and within 30 days before to 60 days after discontinuation of the initial TNFi), and continuous insurance ≥6 months before (baseline period) and ≥12 months after the switch date (study period). Patient demographic and clinical characteristics were measured during the baseline period. All-cause and RA-related HRU and costs were analyzed during the 12-month study period using multivariable regression analysis controlling for baseline characteristics and selected comorbidities.
Of the 1577 patients with RA that switched therapies, 1169 patients used another TNFi and 408 patients used a non-TNFi biologic. The most commonly used initial TNFi treatments were etanercept (50%) and adalimumab (34%) among the TNFi cohort, and infliximab (39%) and etanercept (28%) among the non-TNFi cohort. The TNFi cohort had significantly fewer outpatient visits [all-cause: 23.01 vs. 29.77 visits/patient/year; adjusted incidence rate ratio (IRR) = 0.78, P < 0.001; RA-related: 7.42 vs. 13.58; adjusted IRR = 0.58, P < 0.001] and rheumatologist visits (all-cause: 4.01 vs. 6.81; adjusted IRR = 0.66, P < 0.001; RA-related: 3.23 vs. 6.40; adjusted IRR = 0.58, P < 0.001) than the non-TNFi cohort. All-cause total costs were significantly lower for patients who switched to another TNFi instead of a non-TNFi therapy ($36,932 vs. $44,566; adjusted difference = $7045, P < 0.01), as were total RA-related costs ($26,973 vs. $31,735; adjusted difference = $4904, P < 0.01).
Adult patients with RA discontinuing TNFi therapy who switched to an alternative TNFi incurred lower healthcare costs than patients who switched to a non-TNFi biologic.
KeywordsBiologic therapy switching Economic burden Healthcare utilization Healthcare costs Non-tumor necrosis factor inhibitor Rheumatoid arthritis Rheumatology Tumor necrosis factor alpha inhibitor
Funding for this research was provided by AbbVie, Inc. The article processing charges for this publication were funded by AbbVie, Inc. The study sponsor was involved in all stages of the study research and manuscript preparation, but all authors participated in the design of the study and contributed to the manuscript development. Data were collected by Analysis Group, Inc. and analyzed and interpreted in collaboration with all other authors. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, vouch for the accuracy and completeness of the data reported and the adherence of the study to the protocol, and collectively made the decision to submit the manuscript for publication. Manuscript drafts were prepared by the authors with editorial assistance from a professional medical writer, Shelley Batts, Ph.D., an employee of Analysis Group, Inc., and ultimately paid for by the sponsor, AbbVie, Inc. We would like to thank Cheryl Xiang and Sneha Kelkar of Analysis Group, Inc. for assisting with the data analysis. A synopsis of the current research was presented in poster format at the 2015 American College of Rheumatology Annual Meeting in San Francisco during November 6–11, 2015.
Zheng-Yi Zhou is an employee of Analysis Group, Inc. Jenny Griffith is an employee of AbbVie, Inc. and owns stock/stock options. Ella Xiaoyan Du is an employee of Analysis Group, Inc. Daniel Chin is an employee of AbbVie, Inc. and owns stock/stock options. Keith A. Betts is an employee of Analysis Group, Inc. Arijit Ganguli is an employee of AbbVie, Inc. and owns stock/stock options. Analysis Group, Inc. has received consultancy fees from AbbVie, Inc.
Compliance with Ethics Guidelines
This article does not contain any new studies with human or animal subjects performed by any of the authors. All patient claims information was de-identified to comply with HIPAA, and thus did not require review board approval.
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