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Compliance and Cost of Biologic Therapies for Rheumatoid Arthritis

Medication compliance is associated with lower overall and disease-related healthcare costs in patients with moderate to severe rheumatoid arthritis receiving biologic therapies.
Published Online: Sep 21,2017
Machaon Bonafede, PhD, MPH; Barbara H. Johnson, MBA; Derek H. Tang, PhD, BSPharm; David J. Harrison, PhD; and Bradley S. Stolshek, PharmD

Objectives: To examine the association between treatment compliance with biologics approved for rheumatoid arthritis (RA) and 1-year total and RA-specific nonbiologic healthcare costs.

Study Design: Retrospective analysis of MarketScan Commercial Database claims data from July 1, 2009, to December 31, 2013.

Methods: Non-elderly adults (aged 18-63 years) with RA initiating treatment (index date) with a first-line biologic, with continuous plan enrollment for 6 months preindex and 12 months post index, were eligible. Outcomes included compliance (using proportion of days covered [PDC]) and persistence. Associations between compliance and total and RA-specific nonbiologic costs were assessed.

Results: Data from 14,696 patients were analyzed. Mean PDC (SD) was 0.65 (0.31); 46.8% of patients were persistent on index biologic. Mean total healthcare costs were $44,387 for intravenous abatacept, $40,434 for subcutaneous abatacept, $33,422 for adalimumab, $36,599 for certolizumab pegol, $33,214 for etanercept, $34,381 for golimumab, and $40,188 for infliximab. Compared with poorly compliant patients (PDC <0.2), total nonbiologic incremental costs for more compliant patients with PDC 0.2 to <0.4, 0.4 to <0.6, 0.6 to <0.8, and ≥0.8, respectively, were lower at –$1678 (cost ratio [CR] = 0.91; 95% CI, 0.86-0.97; P = .0025), –$4158 (CR = 0.78; 95% CI, 0.74-0.83; P <.0001), –$5127 (CR = 0.73; 95% CI, 0.69-0.78; P <.0001), and –$7961 (CR = 0.58; 95% CI, 0.56-0.62; P <.0001). The respective RA-related incremental nonbiologic costs, compared to poorly compliant patients, were $186 (CR = 1.08; 95% CI, 1.02-1.15; P = .0067), –$168 (CR = 0.92; 95% CI, 0.87-0.98; P = .0126), –$225 (CR = 0.90; 95% CI, 0.85-0.95; P = .0002), and –$560 (CR = 0.75; 95% CI, 0.71-0.79; P <.0001).

Conclusions: Better compliance was associated with lower overall and RA-related nonbiologic costs.

                                                                                         Am J Pharm Benefits. 2017;9(5):84-90

Rheumatoid arthritis (RA) is a systemic, inflammatory, autoimmune disease that primarily affects the linings (synovial membranes) of the joints. Approximately 1.3 million adults in the United States are estimated to have RA.1 A recent study of the total societal burden of RA estimates an annual healthcare cost of $8.4 billion and total societal cost of $19.3 billion per year.2 Left untreated, 20% to 30% of people diagnosed with RA become work-disabled within 3 years.3 Patients with RA suffer significant impairments in health-related quality of life, which can be alleviated by effective treatment.4

The American College of Rheumatology (ACR) recommends treatment with nonbiologic disease-modifying antirheumatic drugs (DMARDs) for early RA patients with low disease activity and an absence of poor prognostic features, and for early RA patients with moderate disease activity with poor prognostic features.5 ACR recommendations also suggest a more aggressive approach to inhibit the progression of joint damage and other complications from RA that may develop soon after diagnosis. These recommendations include the use of a biologic tumor necrosis factor (TNF) blocker with or without methotrexate in patients who have high disease activity with poor prognostic features. For patients with established RA (disease duration ≥6 months), biologic DMARDs are recommended if they have had an inadequate response to combination therapy with nonbiologic DMARDs. Biologic DMARDs approved by the FDA for first-line treatment of RA include the TNF blockers adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab, and a T-cell co-stimulation blocker, abatacept.

Medication compliance/adherence is an important aspect of any treatment. An analysis of pharmacy claims data across 6 chronic conditions reported adherence rates ranging from 28% to 66%.6 Noncompliance can lead to increased healthcare use, including hospitalizations, fractures, cardiovascular events, and emergency department visits.7-10 Notably, increased healthcare use due to medication noncompliance is associated with increased costs.11-13 In patients using antihypertensive medications, for instance, the cost of using more drugs by compliant patients was less than spending on acute cardiovascular events in noncompliant patients.13

The objective of the current study was to examine and quantify the association between treatment compliance with first-line RA biologics and total and RA-specific nonbiologic healthcare costs over 1 year. Medication cost is a dominant component of healthcare cost among RA patients. Although increasing compliance to RA therapies would increase RA medication costs, some other components of healthcare costs may be reduced, because patients’ improved outcomes may result in lower likelihood of future hospitalizations, physician visits, or disease-related complications.