ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 95

Comparison of Patient Characteristics, Healthcare Costs, and Biologic Persistence Between Patients with Rheumatoid Arthritis Initiating First- or Second-Line Subcutaneous Abatacept, Adalimumab, or Etanercept

S Johnston1, F Lobo2, D McMorrow1, R Fowler1, D Smith1 and A Nadkarni2, 1Truven Health Analytics, Bethesda, MD, 2Bristol-Myers Squibb, Plainsboro, NJ

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Health Services Research

Session Type: Abstract Submissions (ACR)

Background/Purpose: There are currently very limited comparative published data on the characteristics, healthcare costs, and biologic persistence among patients with RA who have been treated with SC abatacept in a real-world care setting. This study compared patient characteristics, healthcare costs, and biologic persistence among patients with RA initiating SC abatacept or one of the two most commonly used SC anti-TNF-α agents, adalimumab and etanercept. Methods: This was a retrospective, observational cohort study using a large US administrative claims database. Patients included in the study had initiated SC abatacept, adalimumab, or etanercept between 1/1/2009 and 10/1/2012 (index), were continuously enrolled for 12 months before (baseline) and ≥3 months after index, were aged ≥18 years at index, and had ≥1 baseline medical claim with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for RA (714.0x). First-line initiators used no biologic pre-index; second-line initiators used only one biologic pre-index. Patient characteristics were measured at baseline. Biologic persistence (follow-up) was defined as the period extending from index until the first occurrence of switch to another biologic, censoring at disenrollment from health insurance, or 12/31/2012. Total healthcare costs (medical and pharmacy) were measured during baseline and follow-up on a per-patient-per-month basis. Changes in healthcare costs from baseline to end of available follow-up were compared using multivariable regression (difference-in-difference method). Biologic persistence was compared using multivariable survival analyses. Results: The study results are shown in the Table. Patients treated with SC abatacept had baseline characteristics indicative of the poorest health status (e.g., higher baseline number of unique diagnoses and baseline costs). In all analyses, SC abatacept had the numerically lowest increase from baseline in healthcare costs and hazards of non-persistence, with differences often being statistically significant.

Table

 

First-line

Second-line

 

SC abatacept (n=163)

Adalimumab (n=7098)

Etanercept (n=8776)

SC abatacept (n=256)

Adalimumab (n=2055)

Etanercept (n=1303)

Baseline number of unique diagnoses, mean (SD)

17.1 (12.8)

14.0 (8.7)

p<0.001

14.3 (8.9)

p<0.001

15.9 (10.4)

14.2 (8.9)

p=0.006

14.3 (8.5)

p=0.011

Baseline number of unique medications, mean (SD)

18.0 (10.4)

15.3 (9.3)

p<0.001

15.4 (9.5)

p<0.001

18.7 (9.9)

17.5 (9.7)

p=0.082

18.1 (10.1)

p=0.44

Baseline healthcare costs, mean (SD)

$2025 ($2843)

$1153 ($1725)

p<0.001

$1199 ($1944)

p<0.001

$2663 ($2462)

$2162 ($1779)

p<0.001

$2231 ($1941)

p<0.001

Adjusted healthcare cost difference*

ref.

$640

p=0.0012

$657

p=0.0010

ref.

$120

 p=0.0425

$94

p=0.1304

Adjusted hazard ratio of non-persistence*

ref.

1.504

p=0.1241

1.691

p=0.0466

ref.

1.982

p=0.0003

1.737

p=0.0057

*As calculated using difference-in-difference; positive $ value indicates lower increase from baseline in healthcare costs for SC abatacept; hazard ratio >1 indicates lower hazards of non-persistence (longer durations of persistence) for SC abatacept.

Conclusion: In this study of patients with RA initiating first- or second-line biologics, SC abatacept was initiated in patients with poorest health status and therefore higher baseline healthcare costs compared with adalimumab or etanercept. Despite this, SC abatacept often had the lowest increase from baseline in healthcare costs and longest duration of biologic persistence.  

Disclosure:

S. Johnston,

Truven Health Analytics,

3;

F. Lobo,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

2,

Bristol-Myers Squibb,

3;

D. McMorrow,
None;

R. Fowler,

Truven Health Analytics,

3;

D. Smith,

Truven Health Analytics,

3;

A. Nadkarni,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3.

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