Background Rheumatoid arthritis (RA) is an inflammatory disorder associated with a significant physical and psychological burden. Patients with RA experience a lower quality of life than patients without RA. This study utilizes Taiwan's National Health Insurance Database (NHIRD) which is a claims-based database recording all interactions with the National Health Insurance (NHI) system.
Objectives The objective of this study was to use the NHIRD to estimate the percentage of newly treated patients with inadequate response (IR) to biologic disease-modifying antirheumatic drugs (bDMARDs) as well as the costs and resources.
Methods Data were from the catastrophic illness file within the NHIRD from 1/1/2009 to 12/31/2013. The index period spanned 2010 with a pre-index period consisting of the index date – 365 days, and patient follow-up was index date to 365 days post-index. Patients with a catastrophic illness card for RA were included in the study. Biologically-naïve patients included those who did not have a claim for a bDMARD or exclusion diagnoses in the pre-index period. Biologically-naïve patients with a bDMARD claim were indexed upon their first claim for a bDMARD during the index year. A validated algorithm was used to examine the rate of inadequate response in the biologically-naïve cohort of patients. Inadequate responders met one or more of the following criteria during their year of follow-up: low adherence (proportion of days covered <0.80); switched to or added a second bDMARD; added a new conventional synthetic DMARD (csDMARD); received ≥1 glucocorticoid injection; or increased oral glucocorticoid dosing. All-cause mean annual direct costs and resource use were measured in the year of follow-up. Costs were converted from NT$ to EUR using 1 NT$ =0.03 EUR.
Results A total of 818 biologically-naïve patients initiated a bDMARD and were included in the study. At 1 year of follow-up, 66.01% (n=540) were classified as bDMARD-IR, 31.54% (n=258) were classified as confirmed stable, and 2.44% (n=20) were of unknown response status. Mean annual total direct costs in the follow-up year were €14,669 and €12,867 for the confirmed stable and inadequate responder cohorts, respectively. Mean annual non-medication costs were 40.4% (€578) higher for the IR cohort, and mean annual medication costs were 17.2% (€2,379) higher for the confirmed stable cohort. IR patients had higher mean annual resource utilization in the follow-up year with increases in hospital admissions (0.46 vs. 0.1), hospital days (3.4 vs. 0.49), outpatient visits (42.50 vs. 37.66), and emergency department visits (0.51 vs. 0.3).
Conclusions A significant proportion of patients with RA initiating a bDMARD for the first time showed an IR to their treatment within a year. Patients with an IR had increased resource utilization and higher non-medication costs than those with stable disease. This level of IR suggests an unmet need in the RA treatment paradigm.
Disclosure of Interest Q. Shi Employee of: Eli Lilly & Co., T. Treuer Employee of: Eli Lilly & Co., B. Wang Consultant for: Eli Lilly & Co., C. Gaich Employee of: Eli Lilly & Co., C.-H. Lee Employee of: Eli Lilly & Co., W.-S. Wu Employee of: Eli Lilly & Co., W. Furnback Consultant for: Eli Lilly & Co., K.-J. Li: None declared, C.-H. Tang: None declared
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