PBI9 The TOTAL Medical Expenditure and out-of-Pocket Expenditure of Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Patients in the United States

Abstract

Rheumatoid Arthritis (RA) is a chronic disease that leads to significant pain, progressive joint destruction, and functional disability. Given the incurable nature, the condition causes a significant and persistent economic burden in the U.S. and worldwide. The goal is to explore the total medical expenditure, and out-of-pocket (OOP) expenditure among the following RA medication groups: non-Disease-Modifying Antirheumatic Drugs (DMARDs); TNF alpha biologics; conventional DMARDs; combined TNF alpha biologics and conventional DMARDs. This is a retrospective observational study based on the Medical Expenditure Panel Survey Household Component (MEPS-HC) data for a cohort of individuals from 2016 to 2018. A descriptive analysis measured the patient sociodemographic and personal characteristics. Weighted mean and standard deviation (SD) or the weighted median and interquartile range (IQR) were reported for the continuous variables. A chi-square test was performed to evaluate the difference of any OOP expenditure among RA patients in different medication groups. A multivariate regression with logarithmic transformation was used to estimate the relationship between total medical expenditure and RA therapeutic medication class by adjusting the confounding covariates. 1,758 adult RA patients with 10,434 RA-related events with at least one visit to the healthcare provider between 2016 and 2018 were identified. The average total medical expenditure was significantly higher in RA patients with any type of DMARD, residing in the Western U.S., diagnosed with 2 or more comorbidities, and 2 or more health resource visits. The DMARDs groups were more likely to have some positive OOP expenditures, including all patients in the TNF alpha biologics group. RA patients with TNF alpha biologics encounter higher total medical expenditure and OOP expenditures; however, they may experience fewer or no occurrences of high-cost drivers of healthcare utilization. Average OOP expenditures increased from 2016 to 2018 in RA patients with any biologic DMARD.