ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1033

Burden of Illness in Patients with RA and Anti-Cyclic Citrullinated Peptide Positivity

ML Paudel1, JP Swindle1, J McPheeters1, R Szymialis2 and K Price2, 1Optum, Inc., Eden Prairie, MN, 2Bristol-Myers Squibb, Princeton, NJ

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , ,

Session Information

Date: Monday, November 6, 2017

Session Title: Health Services Research Poster II: Osteoarthritis and Rheumatoid Arthritis

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: RA is often treated with a biologic DMARD (bDMARD), such as abatacept (ABA) or a TNF inhibitor (TNFi). Real-world data on how economic outcomes vary by bDMARD therapy in patients (pts) with seropositivity to anti-cyclic citrullinated peptide (anti-CCP) are sparse. The objective of this study was to compare healthcare resource utilization (HCRU) and costs among pts with RA and anti-CCP positivity who initiated a new bDMARD therapy. Methods: A retrospective study was conducted using claims data from a large US health plan, linked with laboratory results. Pts were aged ≥18 years with ≥1 diagnosis code for RA (ICD-9-CM 714.x) and ≥1 claim for ABA (identified first) or a TNFi (adalimumab, certolizumab pegol, etanercept, golimumab or infliximab) during Jan 1, 2007–Jul 31, 2015. Cohort assignment was based on index therapy (ABA or first observed TNFi). Pts were required to have ≥18 months of continuous health plan enrollment (≥6 months pre-index [pre-initiation], 12 months post-index [post-initiation]), no pre-index claims for index therapy and anti-CCP positivity (≥20 IU/mL). Per-pt-per-month HCRU and costs (total and RA-related) were calculated separately for the pre- and post-index periods. Independent sample t-tests were used to examine differences by cohort. Results: Analyses included 203 ABA users and 1066 TNFi users (etanercept=487, adalimumab=331, infliximab=144, certolizumab=60, golimumab=44) with anti-CCP positivity (median age 55 & 52 years, female 88 & 75%, Medicare Advantage 17 & 15%; mean Charlson Comorbidity Index score 1.6 & 1.4, pre-index bDMARD use 48 & <1%). Compared with TNFi users, ABA users experienced greater mean ambulatory visits in pre-index (2.6 vs 2.0, p<0.01) and post-index periods (2.6 vs 1.7, p<0.01). No statistically significant differences (p<0.05) in mean emergency room visits or inpatient days for the pre- or post-index periods were observed between cohorts. Compared with TNFi users, ABA users experienced higher mean costs in pre-index ($2543 vs $932, p<0.01) and post-index periods ($3632 vs $2957, p<0.01). Analyses of RA-related costs and utilization were similar, with the exception that a statistically significant difference was not observed in post-index RA-related costs between ABA and TNFi users ($2660 vs $2306, p=0.06).

Conclusion: Among pts with RA and anti-CCP positivity, unadjusted differences in pre-index ambulatory care and healthcare costs were observed between abatacept and TNFi users, which carried over to post-index cost and HCRU comparisons. These differences appeared to be driven, in part, by greater ambulatory care among abatacept users. Further research is needed to understand additional factors driving pre-index costs among pts initiating bDMARDs to treat RA, to inform multivariable adjusted analyses and ensure comparability of cohorts, as abatacept is likely to be their second line of therapy due to formulary availability.

Table 1. Per-Patient-Per-Month Costs and Healthcare Resource Utilization by Biologic DMARD Group
6 months pre-index 12 months post-index
Abatacept TNFi Abatacept TNFi
Healthcare costs, USD, mean (SD)        
Total healthcare costs 2543 (3283) 932 (1668)* 3632 (3480) 2957 (2457)*
RA-related healthcare costs 1379 (1660) 310 (1168)* 2660 (2567) 2306 (1785)
Healthcare resource utilization, mean (SD)        
Total ambulatory visits 2.62 (1.86) 1.96 (1.42)* 2.56 (1.73) 1.68 (1.35)*
Total ER visits 0.11 (0.29) 0.07 (0.28) 0.10 (0.29) 0.06 (0.19)
Total inpatient days 0.12 (0.72) 0.06 (0.67) 0.12 (0.58) 0.09 (0.47)
RA-related ambulatory visits 1.02 (0.75) 0.74 (0.48)* 1.15 (0.66) 0.61 (0.46)*
RA-related ER visits 0.03 (0.09) 0.01 (0.07) 0.02 (0.04) 0.01 (0.06)
RA-related inpatient days 0.10 (0.69) 0.05 (0.66) 0.11 (0.54) 0.08 (0.43)
Costs and healthcare resource utilization were reported as per-patient-per-month *p<0.05; statistically significant differences were computed between abatacept and TNFi groups ER=emergency room; TNFi=TNF inhibitor; USD=United States dollars, adjusted to 2016 dollars
   
Disclosure: M. Paudel, None; J. Swindle, None; J. McPheeters, None; R. Szymialis, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3; K. Price, Bristol-Myers Squibb, 1,Bristol-Myers Squibb, 3.

To cite this abstract in AMA style:

Paudel M, Swindle J, McPheeters J, Szymialis R, Price K. Burden of Illness in Patients with RA and Anti-Cyclic Citrullinated Peptide Positivity [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/burden-of-illness-in-patients-with-ra-and-anti-cyclic-citrullinated-peptide-positivity/. Accessed May 26, 2022.

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