Abstract
IntroductionEffective treatment for rheumatoid arthritis (RA) may lead to lower overall and RA-related healthcare utilization. We evaluated healthcare utilization before and after initiation of the tumor necrosis factor inhibitor etanercept in patients with moderate to severe RA.MethodsThis retrospective cohort study used data from the MarketScan® claims database. Data from adult patients with RA newly exposed to etanercept between January 1, 2010 and December 31, 2013 were analyzed. Patients had at least one inpatient or outpatient claim for RA and at least one claim for etanercept (first claim was index date). Etanercept compliance was determined on the basis of proportion of days covered (PDC). Primary outcome was change in overall and RA-related healthcare utilization in the year before and year after etanercept initiation. McNemar’s test and paired t test, respectively, were used to determine statistical significance for dichotomous and continuous variables.ResultsData from 6737 patients were analyzed; mean age was 49.8 years and 77.3% were female. Overall outpatient services, office visits, outpatient hospital services, laboratory visits, and emergency department visits were significantly lower in the post-index period compared to pre-index. RA-related pharmacotherapy use (oral corticosteroids, opioid analgesics, nonsteroidal anti-inflammatory drugs, and nonbiologic disease-modifying antirheumatic drugs) was significantly lower in the post-index period compared to pre-index. Rates of RA-related total joint arthroplasty, joint reconstructions, and soft tissue procedures were similar in pre-index and post-index periods. High etanercept compliance (PDC ≥80%) was associated with significantly lower rates of RA-related outpatient services, office visits, diagnostic imaging studies, and joint reconstructions compared with noncompliance.ConclusionOverall healthcare utilization decreased after etanercept initiation. Patients who were most compliant with etanercept had significantly lower utilization than less compliant patients.FundingAmgen, Inc
Highlights
Effective treatment for rheumatoid arthritis (RA) may lead to lower overall and RA-related healthcare utilization
Tumor necrosis factor inhibitors (TNFi), including adalimumab, etanercept, infliximab, golimumab, and certolizumab pegol, are a class of biologic DMARDs (bDMARDs) that are currently approved to treat moderate to severe RA
RA-Related Pharmacotherapy Use of nbDMARDs, oral corticosteroids, oral opioid analgesics, and oral nonsteroidal anti-inflammatory drugs (NSAIDs) was significantly lower after initiation of etanercept therapy (P\0.001) (Fig. 2)
Summary
Effective treatment for rheumatoid arthritis (RA) may lead to lower overall and RA-related healthcare utilization. We evaluated healthcare utilization before and after initiation of the tumor necrosis factor inhibitor etanercept in patients with moderate to severe RA. Data from adult patients with RA newly exposed to etanercept between January 1, 2010 and December 31, 2013 were analyzed. Tumor necrosis factor inhibitors (TNFi), including adalimumab, etanercept, infliximab, golimumab, and certolizumab pegol, are a class of bDMARDs that are currently approved to treat moderate to severe RA. Patients with RA have high healthcare utilization (HCU) and costs compared to individuals without RA. A study from the Swedish National Patient Register using data from 2010 reported that mean annual costs were 2–3 times higher in RA patients than in the general population in 2010 [3]. The efficacy of bDMARDs in treating RA has led to lower hospitalization rates and lower rates of work disability, which can offset some of the medication costs [4]
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