Grabner Michael, Boytsov Natalie N, Huang Qing, Zhang Xiang, Yan Tingjian, Curtis Jeffrey R
HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801, USA.
Eli Lilly & Company, Indianapolis, IN, USA.
Arthritis Res Ther. 2017 May 15;19(1):92. doi: 10.1186/s13075-017-1293-1.
Tumor necrosis factor inhibitors (TNFi) are common second-line treatments for rheumatoid arthritis (RA). This study was designed to compare the real-world clinical and economic outcomes between patients with RA who responded to TNFi therapy and those who did not.
For this retrospective cohort analysis we used medical and pharmacy claims from members of 14 large U.S. commercial health plans represented in the HealthCore Integrated Research Database. Adult patients (aged ≥18 years) diagnosed with RA and initiating TNFi therapy (index date) between 1 January 2007 and 30 April 2014 were included in the study. Treatment response was assessed using a previously developed and validated claims-based algorithm. Patients classified as treatment responders in the 12 months postindex were matched 1:1 to nonresponders on important baseline characteristics, including sex, age, index TNFi agent, and comorbidities. The matched cohorts were then compared on their all-cause and RA-related healthcare resource use, and costs were assessed from a payer perspective during the first, second, and third years postindex using parametric tests, regressions, and a nonparametric bootstrap.
A total of 7797 patients met the study inclusion criteria, among whom 2337 (30%) were classified as treatment responders. The responders had significantly lower all-cause hospitalizations, emergency department visits, and physical/occupational therapy visits than matched nonresponders during the first-year postindex. Mean total all-cause medical costs were $5737 higher for matched nonresponders, largely driven by outpatient visits and hospitalizations. Mean all-cause pharmacy costs (excluding costs of biologics) were $354 higher for matched nonresponders. Mean RA-related pharmacy costs (conventional synthetic and biologic drugs), however, were $8579 higher in the responder cohort, driven by higher adherence to their index TNFi agent (p < 0.01 for all comparisons). A similar pattern of cost differentiation was observed over years 2 and 3 of follow-up.
In this real-world study we found that, compared with matched nonresponders, patients who responded to TNFi treatments had lower all-cause medical, pharmacy, and total costs (excluding biologics) up to 3 years from initiation of TNFi therapy. These cost differences between the two cohorts provide a considerable offset to the cost of RA medications and should encourage close monitoring of treatment response to minimize disease progression with appropriate therapy choices.
肿瘤坏死因子抑制剂（TNFi）是类风湿性关节炎（RA）常见的二线治疗药物。本研究旨在比较接受TNFi治疗有反应的RA患者和无反应患者在现实世界中的临床和经济结局。
在这项回顾性队列分析中，我们使用了HealthCore综合研究数据库中14家美国大型商业健康保险计划成员的医疗和药房理赔数据。研究纳入了2007年1月1日至2014年4月30日期间诊断为RA并开始TNFi治疗（索引日期）的成年患者（年龄≥18岁）。使用先前开发并验证的基于理赔的算法评估治疗反应。在索引后12个月内被分类为治疗有反应者的患者，在重要的基线特征（包括性别、年龄、索引TNFi药物和合并症）方面与无反应者进行1:1匹配。然后比较匹配队列在全因和RA相关医疗资源使用方面的情况，并使用参数检验、回归分析和非参数自助法从支付方角度评估索引后第一年、第二年和第三年的费用。
共有７７９７名患者符合研究纳入标准，其中2337名（30%）被分类为治疗有反应者。在索引后第一年，有反应者的全因住院、急诊就诊以及物理/职业治疗就诊次数均显著低于匹配的无反应者。匹配的无反应者的全因医疗费用平均高出5737美元，主要由门诊就诊和住院费用驱动。匹配的无反应者的全因药房费用（不包括生物制剂费用）平均高出354美元。然而，由于对索引TNFi药物的依从性更高，有反应者队列的RA相关药房费用（传统合成药物和生物制剂）平均高出8579美元（所有比较p<0.01）。在随访的第二年和第三年观察到类似的费用差异模式。
在这项现实世界研究中，我们发现，与匹配的无反应者相比，接受TNFi治疗有反应的患者在开始TNFi治疗后的3年内，全因医疗、药房和总费用（不包括生物制剂）更低。这两个队列之间的费用差异相当程度地抵消了RA药物的费用，应鼓励密切监测治疗反应，以通过适当的治疗选择将疾病进展降至最低。
