Abstract
Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are chronic progressive immune-mediated rheumatic diseases (IMRD) that can cause a progressive disability and joint deformation and thus can impact in healthcare resource utilization (HCRU) and costs. The main outcome of the study was to assess the effect of non-persistence to treatment with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFis) on HCRU costs in naïve patients with IMRD who started treatment with adalimumab, etanercept, golimumab or certolizumab pegol during 12 months after initiation of treatment. The impact of persistence and non-persistence of SC-TNFis on HCRU costs was compared between 12 months before and 12 months after initiating SC-TNFis. Persistence was defined as the duration of time from initiation to discontinuation of therapy. The study was conducted in an acute care teaching hospital in Barcelona, Spain. Data for the period between 2015 and 2018 were extracted from the hospital cost management control database. HCRU costs comprised outpatient care, outpatient specialized rheumatology care, in-patient care, emergency care, laboratory testing and other non-biological therapies. The study population included 110 naïve SC-TNFis patients, divided into the cohorts of persistent (n = 85) and non-persistent (n = 25) patients. Fifty-six percent of patients were women, with a mean (standard deviation) age of 47.6 (14.8) years. Baseline clinical features and HCRU costs over the 12 months before the index prescription were similar in the two study groups. Before-and-after differences in mean (standard deviation) HCRU costs were significantly higher in the non-persistence group as compared to the persistence group for outpatient rheumatology care (€110.90 [234.56] vs. €20.80 [129.59], p = 0.023), laboratory testing (−€193.99 [195.88] vs. −€241.3 [217.88], p = 0.025), other non-biological drugs (€3849.03 [4046.14] vs. −€10.90 [157.42], p < 0.001) and total costs (€3268.90 [4821.55] vs. −€334.67 (905.44), p < 0.001). Treatment persistence with SC-TNFis may be associated with HCRU cost savings in naïve IMRD patients. Prescribing SC-TNFis with the best long-term persistence is beneficial.
Highlights
Immune-mediated rheumatic diseases (IMRD) including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic progressive diseases that impair and deteriorate joint function and structure (Sangha, 2000; Verstappen and Carmona, 2018)
Between January 1st, 2015, and December 30th, 2018, all consecutive patients aged 18 years or older diagnosed with RA (ICD-10 code M05.9), PsA (ICD-10 code L40.5), AS and other spondyloarthropathies (ICD-10 codes M08.1, M45, M48.8) who fulfilled the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, the classification criteria for Psoriatic arthritis (CASPAR), the Modified New York criteria for AS or the Assessment of Spondylarthritis International Society (ASAS) classification criteria for axial SpA respectively, and who were candidates to initiate treatment with SC-TNFis were eligible
There were no significant differences between the persistent and non-persistent groups in the distribution of patients according to IMRD disorder, with RA accounting for 43.6% of the cases followed by spondyloarthritis in 25.4%, and PsA in 11.8%
Summary
Immune-mediated rheumatic diseases (IMRD) including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic progressive diseases that impair and deteriorate joint function and structure (Sangha, 2000; Verstappen and Carmona, 2018). Poor adherence to long-term therapies severely, compromises effectiveness and safety outcomes, making patient adherence a critical issue from the perspective of the patient to achieve the lowest possible level of disease activity, optimize functional status and improve quality of life, as well as from the perspective of health economics (Chastek et al, 2017; Usherwood, 2017). In the particular case of golimumab, a retrospective database analysis of 353 patients with rheumatic diseases receiving biological drugs, the probability of retention of golimumab at 1, 2, 3, 4, and 5 years was 85.9, 73.7, 68.5, 60.6, and 57.1%, respectively, with similar percentages across all indications and significantly greater when used as first biological agent compared with later therapies (Hernandez et al, 2019). In a systematic review of real-world treatment persistence of golimumab in the management of IMRD in Europe based on 27 studies, persistence at 24 months was about 50%, with lower persistence among axial AS (43%), but significantly better or equal persistence to other TNFis (Luttropp et al, 2019)
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