ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1458

Rates Of Switching and Healthcare Costs Associated With Switching Biologic Disease-Modifying Antirheumatic Drugs In a Commercial Population: Evidence From Real-World Observational Studies

A Nadkarni, F Lobo and T Juday, Bristol-Myers Squibb, Plainsboro, NJ

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy II

Session Type: Abstract Submissions (ACR)

Background/Purpose: Several biologic disease-modifying antirheumatic drugs (bDMARDs) are approved for the treatment of moderate-to-severe RA. Switching between bDMARD therapies is common in real-world settings, and may have an impact on healthcare costs. This analysis evaluated bDMARD switching and associated healthcare costs in patients with RA across two commercially insured populations in the US. Methods: Two retrospective cohort studies of adult patients with RA who initiated a bDMARD were conducted using US commercial insurance claims databases. Patients were categorized into first- and second-line bDMARD cohorts. The first-line bDMARD cohort included patients who newly initiated a bDMARD (adalimumab, etanercept, infliximab, or abatacept). The second-line bDMARD cohort included patients who initiated a second bDMARD. Patients in both first- and second-line bDMARD cohorts were required to have continuous eligibility 6 months before (pre-index) and 12 months after (post-index) initiation of first- or second-line bDMARD treatment. Patients in both cohorts were categorized into switchers and non-switchers. Switchers had a claim for a different bDMARD within a 200% gap in days supply for the index bDMARD. Non-switchers stayed on their index bDMARD in the post-index period. Switch rates were compared for each bDMARD. Patients who discontinued their index bDMARD and did not switch in the post-index period were excluded from the analyses. Rates of bDMARD switching, and pre- and post-index healthcare costs for switchers and non-switchers were examined. Results: The first- and second-line bDMARD cohorts included 10,281 and 2354 patients, respectively, in Study 1, and 6320 and 1297 patients, respectively, in Study 2. In both studies, rates of switching for the first- and second-line bDMARD cohorts were lower for abatacept compared with adalimumab, etanercept, and infliximab (Table 1). Pre- and post-index healthcare costs in both studies were higher for first- and second-line bDMARD switchers compared with non-switchers (Table 2).  

Table 1.
Index bDMARD Proportion of first-line bDMARD cohort who switched bDMARD during post-index period Proportion of second-line bDMARD cohort who switched bDMARD during post-index period
Study 1 Study 2 Study 1 Study 2
Adalimumab 8.9% 10.5%* 15.2% 19.1%*
Etanercept 8.5% 9.5% 13.3% 17.4%
Infliximab 5.2% 10.3% 13.5% 22.7%*
Abatacept 2.0% 6.5% 7.4% 12.6%
*p<0.05 vs abatacept.  

Table 2.
  First-line bDMARD switchers versus non-switchers Second-line bDMARD switchers versus non-switchers
Study 1 Study 2 Study 1 Study 2
Pre-index monthly healthcare costs $1025 vs $796* $2417 vs $2081* $2173 vs $1856* $3705 vs $3719
Post-index monthly healthcare costs $3759 vs $2343* $6081 vs $4415* $3956 vs $2616* $8376 vs $5625*
*p<0.05.

Conclusion: Patients on first- or second-line abatacept switched less frequently than patients on other bDMARDs. Post-index monthly healthcare costs were higher for first- and second-line bDMARD switchers versus non-switchers, suggesting there may be an economic benefit to using abatacept as the first- or second-line bDMARD in patients with moderate-to-severe RA.  

Disclosure:

A. Nadkarni,

Bristol-Myers Squibb,

3,

Bristol-Myers Squibb,

1;

F. Lobo,

Bristol-Myers Squibb,

3;

T. Juday,

Bristol-Myers Squibb,

3.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rates-of-switching-and-healthcare-costs-associated-with-switching-biologic-disease-modifying-antirheumatic-drugs-in-a-commercial-population-evidence-from-real-world-observational-studies/