Session Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity
Session Type: Abstract Submissions (ACR)
Background/Purpose: Examine the impact of a claims-based severity index for rheumatoid arthritis (RA) on healthcare costs and utilizations of RA patients using large U.S. claims data.
Methods: Adult patients with at least two RA diagnoses and 12 months of continuous health plan enrollment before and after the index date (first RA diagnosis date) were identified from a large U.S. claims database (10/1/2008 to 09/30/2009). A severity index for rheumatoid arthritis (SIFRA) was developed by calculating a weighted sum of 34 RA-related indicators including laboratory, clinical and functional status, extra-articular manifestations, surgical history, and medications as assessed by an expert Delphi panel of six rheumatologists. The relationship between SIFRA terciles and healthcare utilizations and costs was also examined using histograms. A regression model was used to examine the improvement of the model fitting by adding SIFRA.
Results: A total of 23,951 RA patients (mean SIFRA: 9.14) with laboratory information were identified. Descriptive analysis showed that patients in the upper tercile of SIFRA incurred $9,123 more all-cause healthcare costs and $1,326 more RA-related healthcare costs than patients in the lower tercile of SIFRA. The most dramatic difference between highest and lowest SIFRA terciles occurred with pharmacy costs ($6,860 vs. $1,919, p<0.001). Healthcare visits followed a similar to healthcare costs for SIFRA terciles. Patients in the highest SIFRA tercile had higher total office visits (110.14 vs. 77.16, p<0.001) and higher RA-related visits (6.72 vs. 3.93, p<0.001) compared to patients in the lowest tercile. Regression results showed that the model was more than 6-times (611%) superior in explaining the variation in outcomes after adding SIFRA into the model.
Conclusion: SIFRA demonstrated evidence of being a significant determinant of healthcare costs and utilizations for RA patients. This study suggests that SIFRA could be an important methodological tool to control for severity in RA-related outcomes research.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-severity-index-for-rheumatoid-arthritis-on-healthcare-costs-and-utilizations-in-patients-with-rheumatoid-arthritis/