Background/Purpose: Patients with rheumatoid arthritis (RA) who have an inadequate response to a tumor necrosis factor inhibitor (TNFi) can switch to another targeted disease-modifying antirheumatic drug (DMARD), either by changing to another TNFi (“cycling”) or by switching to a new mechanism of action (“new MOA switching”). Given potential differences in outcomes conditional on choosing either of these strategies, this study examined the cost per effectively treated patient in the first year after TNFi cycling or new MOA switching.

Methods: This claims-based analysis included a cohort of patients with RA in the Truven Health Analytics MarketScan Commercial database who either cycled from a TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) to another TNFi or switched to a new MOA biologic (abatacept or tocilizumab) or targeted oral DMARD (tofacitinib) between January 2010 and December 2014. A validated claims-based algorithm was applied to estimate treatment effectiveness for the 12-month post-switch period based on six criteria: 1) adherence ≥80%; 2) no dose increase; 3) no addition of a synthetic DMARD (leflunomide, methotrexate, sulfasalazine, or hydroxychloroquine); 4) no switch to another targeted DMARD; 5) no new/increased oral glucocorticoid; and 6) intra-articular injections on <2 days. Costs were calculated from healthcare claims based on the paid amount for targeted DMARDs, adjusted for inflation according to price changes for the individual medications during the study period. Cost per effectively treated patient was defined as the average 12-month post-switching cost per patient for targeted DMARDs divided by the proportion of patients categorized by the algorithm as effectively treated. Bivariate analysis was conducted to compare treatment effectiveness and costs between TNFi cyclers and new MOA switchers.

Results: A total of 8,517 patients were analyzed (5,997 TNFi cyclers and 2,520 new MOA switchers). TNFi cyclers and new MOA switchers had similar age (mean±SD, 49.7±9.6 vs 51.0±9.3 years), sex (female, 81.2% vs 83.9%), and comorbidity (mean±SD Deyo-Charlson index score, 1.4±0.8 vs 1.5±1.0). Costs and treatment effectiveness favored new MOA switchers over TNFi cyclers, resulting in higher cost per effectively treated patient for TNFi cycling vs new MOA switching. Differences in adherence, subsequent treatment switches, and dose increases were major drivers of cost effectiveness (Table).

Conclusion: After prior exposure to TNFi, switching to a new MOA rather than cycling to another TNFi was associated with better treatment effectiveness and lower drug costs, resulting in lower cost per effectively treated patient.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/claims-based-analysis-of-cost-effectiveness-among-patients-with-rheumatoid-arthritis-who-switched-from-a-tumor-necrosis-factor-inhibitor-to-another-targeted-disease-modifying-antirheumatic-drug/