Objectives To apply a validated claims-based severity index for rheumatoid arthritis (SIFRA) to prevalent RA groups in Turkey to determine the effects of RA severity on healthcare costs and biologic use.
Methods Using medical and pharmacy claims and eligibility data from the Turkish national health insurance database MEDULA for RA patients in Turkey (01JUN2009-31DEC2011), prevalent RA patients age 18-99, with two RA diagnoses ≥60 days apart and continuously enrolled 1 year pre- and post-index date (first RA claim 01JUN2009-31DEC2010) were analyzed. SIFRA was calculated for the baseline period. Healthcare costs and biologic use were examined for the follow-up period. Chi-square tests were used to find SIFRA score and outcome association. Generalized linear models were used to determine costs, and multivariate logistic regression were used to determine SIFRA effect.
Results 1,920 RA patients were identified. Mean SIFRA score was 14.21, and 7.05 (49.57%) included clinical and functional status variables, medications: 6.32 (44.47%); radiology and laboratory results: 0.48 (3.40%), and extra-articular manifestation: 0.32 (2.25%). Controlling for age, gender, region, and comorbidity index, high SIFRA tercile patients were 5.16 times more likely to be prescribed biologics (p<0.001, CI: 3.46-7.69), and incurred higher costs €2,091 (p<0.001, CI: €1,557-€2,625) than those in the low SIFRA tercile.
Conclusions RA severity varies in Turkey, and is a determinant of healthcare costs and biologic therapy use. Biologic use positively correlated with severity score. Future comparative effectiveness studies in RA treatment should include severity scores.
Disclosure of Interest None Declared