Background Biotherapies such as subcutaneous tumour necrosis factor-alpha inhibitors (SC-TNFis) have transformed the management of rheumatoid diseases. The assessment of SC-TNFis non-persistence and its impact on medical resource utilization and costs are needed.
Objectives The objective was to assess the impact of non-persistence to subcutaneous TNF-alpha inhibitors on medical resource utilization and costs, for patients initiating treatment with an SC-TNFi in France.
Methods The Système National d'Information Inter-régime [French national health insurance scheme information-sharing system] (SNIIRAM) database lists all outpatient and inpatient healthcare consumption for individuals covered by the general health insurance scheme. Using French claims data, conditions were diagnosed using Long Term Disease status and hospital admission, based on ICD-10 codes of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Patients were then identified through first-line prescription filled for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP) and golimumab (GLM) between 2012/07/01 and 2012/12/31. 12-months persistence status was estimated with Kaplan Meier analysis. A patient was considered as non-persistent in the event of a prolonged interruption of the therapy during 91 days or more. Persistent and non-persistent patients were compared, after a 1:1 propensity score matching, in term of medical resource utilization and costs (from a National Health Service perspective) in the subsequent 12-month period.
Results Among 3,804 patients initiating treatment with an SC-TNFi in France between 2012/07/01 and 2012/12/31, 2,133 were classified as persistent at 12 months and 1,671 as non-persistent. After the 1:1 propensity score matching, 1,575 patients were studied in each group. Persistent patients had a lower overall cost than non-persistent patients (-787€): persistent patients had higher costs for drugs (+3,283€), due to the cost of biotherapies, but had lower costs associated to non-drugs (-1,592€) and hospital admissions (-2,478€).
Conclusions The results indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs, particularly for hospital admissions. However, as always the case with observational data, residual confounding factors could explain part of the results (e.g. disease severity).
Disclosure of Interest M. Belhassen Employee of: PELyon, F. Tubach: None declared, C. Hudry Consultant for: ABBVIE, MSD, BMS, PFIZER, ROCHE, CELGENE, NOVARTIS, BIOGEN, UCB, SANDOZ, AMGEN., Employee of: COCHIN Hospital, M.-C. Woronoff: None declared, L. Levy-Bachelot Employee of: MSD France, L. Lamezec Employee of: MSD France, E. Van Ganse Consultant for: PELyon; ALK ABELLO; AstraZeneca; Bayer; BMS; BIF; GSK; IMS; LASER; MSD, B. Fautrel Grant/research support from: AbbVie, MSD, Pfizer, Consultant for: AbbVie, Biogen, BMS, Celgène, Hospira, Janssen, Lilly, MSD, NORDIC Pharma, Pfizer, Roche, SOBI, UCB