Background/Purpose: Type 2 diabetes mellitus (T2DM)-related complications are costly, and there is lack of information regarding the comparative impact of target disease-modifying anti-rheumatic drugs (tDMARDs) on commercially insured rheumatoid arthritis (RA) patients with T2DM. The objective of this study was to compare T2DM-related healthcare resource utilization (HCRU) and associated costs in TNF-a inhibitors (TNFi)-experienced patients with RA and T2DM receiving abatacept, other non-TNFi, or TNFi.

Methods: A retrospective, observational study was conducted with Truven MarketScan (January 1, 2008- March 31, 2018).  The study population included TNFi-experienced adult patients with RA and T2DM initiating abatacept, TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or other non-TNFi (tocilizumab, anakinra, sarilumab, rituximab, tofacitinib) in the study period. The date of the tDMARD initiation was assigned as the index date. Patients were eligible in the analysis if they had 2+ diagnosis of RA separately at least 7 days, 1+ diagnoses of T2DM or were treated with anti-diabetes medications, and had at least 12 months of continuous enrollment prior to the index date. Patients with T1DM or malignancy were excluded. The follow-up period ended at earliest of (1) end of patient insurance enrollment; (2) end of overall study period; (3) end of index treatment date due to discontinuation or switching. Patients demographics and key clinical characteristics were measured in the baseline period. T2DM-related HCRU and associated costs including inpatient stay, outpatient visits, ER visits, and pharmacy costs were measured on a per-patient-per-month (PPPM) basis (2018 USD). Patients treated with abatacept were matched to TNFi and non-TNFi cohorts separately by propensity score (PS) adjusted with confounders such as comorbidities, HCRU and costs.

Results: A total of 4,322 patients initiating abatacept, non-TNFi or TNFi were identified. Overall, most patients were female (75.6%) with an average age of 58 years (Table 1). Unadjusted results showed abatacept is associated with the lowest T2DM-related hospitalization rates per 1,000 patients per month compared to non-TNFi and TNFi (12.2 vs 15.9 vs 12.8). Moreover, T2DM-related complication costs (PPPM) in abatacept group was the lowest than non-TNFi and TNFi ($798 vs $1,130 vs $823) (Table 2). After propensity score matching, a total of 971 pairs of abatecept vs non-TNFi patients, and 1,065 pairs of abatecept vs TNFi paitents were included in the adjusted results. Patients initiating abatacept had $267 lower adjusted T2DM-related complication costs as compared to non-TNFi and $92 lower costs than TNFi cohorts (Table 3).

Conclusion: TNFi-experienced RA patients with T2DM who initiated abatacept had lower rates of T2DM-related hospitalization and lower costs compared to patients who initiated a TNFi or other non-TNFi, which were shown in both unadjusted and adjusted results. The findings suggest that abatacept may be able to reduce the complications of T2DM and hereby lower the T2DM-related costs in RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-treatment-of-abatacept-or-other-target-disease-modifying-anti-rheumatic-drugs-and-type-2-diabetes-mellitus-t2dm-related-healthcare-resource-utilization-and-costs-in-commercia/