(214) Lower Healthcare Costs for Commercially Insured Patients with Rheumatoid Arthritis in Remission

Publication Number: 888

Background: Rheumatoid arthritis (RA) affects about 1-2% of adults with annual US costs at $19 billion. Most studies evaluating cost of care have not had sufficient data from real-world settings to describe costs and healthcare utilization by RA disease activity (DA) or therapy.

Objectives: To describe the cost of care and healthcare utilization by rheumatoid arthritis (RA) disease activity states (DA) and therapy.

Methods: This retrospective study linked medical and prescription claims to disease activity measures in electronic health record (EHR) data over 1/1/10-3/31/20 using the Optum Clinformatics Data Mart and Bendcare Columbus Real-World Evidence Platform. Annual mean costs were stratified on disease activity and use of conventional synthetic (cs) DMARDs, biologics, and targeted (ts) DMARDS in a 12-month baseline period. A subgroup analysis compared costs in patients initiating a new RA therapy in the 6 months baseline to months 4-10 after initiation.

Results: A total of 2339 patients contributed a mean of 1.42 years of follow-up. At baseline, 440 (19%) were in remission, 936 (40%) in low DA (LDA), 676 (29%) in moderate DA (MDA) and 287 (12%) in high DA (HDA). The Remission and LDA cohorts were slightly older; all cohorts were predominantly female and Caucasian. Mean annual costs were less for patients in remission ($40,165) versus those in MDA ($56,536) and HDA ($59,279). For patients in remission, csDMARD use was associated with the lowest mean annual cost ($25,564), tsDMARDs highest ($75,453), and TNFi ($69,661) and non-TNFi ($57,299) intermediate. Patients in LDA were similar: $31,251 csDMARDs; $70,422 TNFi; $68,563 non-TNFi, and $97,127 tsDMARDs. In the subgroup initiating a new RA therapy (n=137 TNFi and 107 non-TNFi), 43 (31.4%) and 28 (26.2%) attained LDA/remission (TNFi and non-TNFi respectively), and patients initiating TNFi had a shorter time to remission/LDA compared to non-TNFi initiators (123 vs. 149 days). For those on biologics, annual mean within-person medical ($-2,835.41) and inpatient costs (-$2,718.17) were lower after LDA/remission, but pharmacy costs were higher (post-pre initiation difference $18,326.69).

Conclusions: Higher cost of care was observed as RA disease activity increased, with patients in remission having the lowest costs. Optimizing disease activity can have substantial savings in healthcare costs although it may be offset by the cost of targeted RA therapies. This study was supported by Amgen, Inc.