Background/Purpose: Patients with rheumatoid arthritis (RA) have higher healthcare utilization (HCU) and costs than patients without RA¹. Evidence is mixed as to the impact of biologic treatment on HCU. The purpose of this study was to evaluate HCU before and after etanercept (ETN) initiation.

Methods: We conducted a retrospective cohort study using claims data. Adult RA patients newly exposed to ETN from January 1, 2010 through December 31, 2013 were included. Patients were required to have at least 1 inpatient or outpatient claim for RA (ICD-9-CM 714.0) in the primary position, and at least 1 ETN medication claim; the earliest ETN claim served as index date. Patients were excluded if they had exposure to a biologic DMARD or had a claim for psoriasis, psoriatic arthritis, ankylosing spondylitis, or juvenile idiopathic arthritis. The proportion of days covered (PDC) was calculated and used as a measure of ETN compliance. The primary outcome was the change in HCU (both overall and RA-related) in the year before and after ETN initiation. McNemar’s test and paired t-test were used to determine statistical significance for dichotomous and continuous variables, respectively. To compare the HCU across ETN compliance groups, F-test and Chi-square test were used for categorical and continuous variables, respectively.

Results: We identified 6,737 ETN initiators. The mean age was 49.8 years and 77.3% were female. Frequency of medication use for oral corticosteroids, opioid analgesics, NSAIDS and NB-DMARDS decreased significantly from the pre-index to post-index period (Table 1). There was a significant decrease in overall outpatient services, ED visits and hospitalizations from the pre-index to post-index period (data not shown). In the post-index period, there was a statistically significant decrease in HCU factors with increasing ETN compliance (Table 2).

Conclusion: Health care utilization, including medication use, outpatient services and inpatient admissions decreased after ETN initiation. Patients who were the most compliant with their medication experienced significantly lower utilization than non-compliant patients. The reduction in HCU is consistent with a reduction in disease activity as shown in clinical trials of ETN.² 1.       Michet CJ, et al. Hospitalization Rates and Utilization Among Patients With Rheumatoid Arthritis: A Population-Based Study From 1987 to 2012 in Olmsted County, Minnesota. Mayo Clinic Proceedings. 2015;90:176–183.

2.       Moreland LW, et al. Etanercept therapy in rheumatoid arthritis: a randomized, controlled trial. Annals of internal medicine. 1999 Mar 16;130(6):478-86.