PSY30 LIFE EXPECTANCY AND LIFETIME COST OF RHEUMATOID ARTHRITIS IN THE ERA OF BIOLOGICS IN TAIWAN

Abstract

The National Health Insurance of Taiwan has begun to reimburse biologics for patients with rheumatoid arthritis without copayment in 2005. The objective of this study is to quantify the life expectancy (LE), expected years of life lost (EYLL) and lifetime cost in patients with rheumatoid arthritis (RA) in Taiwan after stratification by age and sex. We identified all incident adult RA cases aged over 16 from the catastrophic illnesses registry of Taiwan during 2001-2016, which were linked with National Health Insurance reimbursement database and national mortality registry to abstract the medical costs and survival information. There were 34,837 cases. Their survivals were followed through the end of 2016 by Kaplan-Meier estimates. We simulated age-, sex-, and calendar year of diagnosis-matched referents from vital statistics of Taiwan and obtained the survival ratio between RA cohorts and referents. A logit transformation plus restricted cubic spline and a rolling over algorithm was used for extrapolation to lifetime. Lifetime cost (including healthcare expenditures of ambulatory care and inpatient care) were further analyzed after stratification by gender. On average, the LE and EYLL of RA patients were 36.8 and 23.7 years, 12.2 and 5.11 years, and 2.52 and 1.47 years for age groups of 17∼49, 50∼64, and >65 respectively. The average lifetime costs were 138,583 USD per female patient, which is higher than 111,108 USD of male, but the costs-per-life year appeared similar between genders. After receiving biologics, RA patients appear to live longer with smaller loss of life expectancy. Although males have higher LE and EYLL, their lifetime costs were lower than those of females. More studies are warranted to explore the cost-effectiveness of different treatment strategies.