Background/Purpose: Rheumatoid arthritis (RA) can be better controlled with the advent of biological disease modified anti rheumatic drug (bDMARDs) and JAK inhibitor (JAKi). However, these medications are expensive. Furthermore, the debate regarding criteria for discontinuation of biologics continues, and at this time there are no clear criteria for discontinuation, and they often continue. Therefore, at present, high medical costs will be required for a long time. Recently, the concept of “financial toxicity,” which refers to the impact of the financial burden of treatment on lifestyle, has been proposed and is treated in the same way as physical treatment-related toxicity. Financial toxicity studies on RA have not yet been conducted. In the present study, we hypothesized that financial toxicity would be exacerbated by the use of expensive bDMARDs and JAKi and examined whether bDMARDs and JAKi exacerbate financial toxicity in RA patients.

Methods: A cross-sectional study using the NinJa database conducted at 49 sites in 2020, a database of RA patients in Japan collected from April 1, 2020 to March 31, 2021. Exposure was defined as the usage of bDMARDs or JAKi.

Outcome measure was a financial toxicity and was measured using COmprehensive Score for financial Toxicity (COST). This scale is a patient reported outcome measure (PROM) consisting of 11 items. The responses are recorded on 5-point Likert Scales (ranging from 0 = strongly disagree to 4 = strongly agree). The score by domains ranges from 0 to 44. Higher scores indicated better results and lower financial toxicity. We analyzed the association between the usage of bDMARDs or JAKi and financial toxicity by multiple regression analysis, in which the adjusted variables were age, gender, DAS28-CRP, years of disease, type of work. We used multiple imputation to deal with missing values.

Results: Of 15553 patients, we excluded 12522 patients with missing COST questionnaire data, 2 patients with missing the usage of bDMARDs or JAKi. 165 patients who the co-payment rates are 0%, 59 patients who did not use of DMARDs. A total of 1579 patients were included in the final analysis. The median age of the patients was 69 years (IQR, 57 to 77), and 79.4% were female. The median disease duration was 12 years (IQR, 6 to 20), the median DAS28-CRP was 1.95 (IQR, 1.38 to 2.64). The median copayment amount was ¥1747.1 (USD 1474.1) per month (IQR ¥589.0 [USD 4.53] to ¥11418.8 [USD 87.77]). The median COST score was 26 (IQR 22-30). The usage of bDMARDs or JAKi have a significant effect on financial toxicity in multivariable linear regression model adjusted for age, sex, disease activity (DAS28-CRP), work status, cancer onset within one-year, (coefficient -1.98, 95% Confidence Interval (CI), -2.63 to -1.33, p < 0.001).

Conclusion: The usage of bDMARDs or JAKi was associated with financial toxicity. This research may lead to the revitalization of research in medical economics in the field of collagen disease, and may lead to a practice that is aware of medical cost and can develop into a practice that is willing to discuss cost issues with its patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-the-usage-of-biological-disease-modified-anti-rheumatic-drug-or-jak-inhibitor-and-the-burden-of-treatment-costs-on-daily-life-financial-toxicity-in-ra-patients-a-cross-secti/