Wu Bingcao, Deshpande Gaurav, Gu Tao, Popelar Breanna, Philbin Michael, Wan George J
a HealthCore, Inc. , Wilmington , DE , USA.
b Xcenda, L.L.C. , Palm Harbor , FL , USA.
J Med Econ. 2017 Nov;20(11):1170-1177. doi: 10.1080/13696998.2017.1362411. Epub 2017 Aug 11.
To evaluate healthcare resource utilization (HRU) and costs among patients who initiated repository corticotropin injection (RCI; H.P. Acthar Gel) treatment for rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).
Patients aged ≥18 years with ≥2 diagnoses for either RA or SLE between July 1, 2006 and April 30, 2015 were identified in the HealthCore Integrated Research Database. Index RCI date was the earliest date of a medical or pharmacy claim for RCI after diagnosis. Baseline characteristics, pre- and post-initiation HRU and costs were assessed using descriptive statistics.
This study identified 180 RA patients (mean age = 60 years, 56% female) and 29 SLE patients (mean age = 45 years, 90% female) who initiated RCI. First RCI use averaged 7.1 and 22.6 months after the initial RA and SLE diagnosis, respectively. After RCI initiation, RA patients incurred significantly lower per-patient-per-month (PPPM) all-cause medical costs ($1,881 vs $682, p < .01) vs the pre-initiation period, driven by lower PPPM hospitalizations costs ($1,579 vs $503, p < .01). Overall PPPM healthcare costs were higher ($2,751 vs $5,487, p < .01) due to higher PPPM prescription costs ($869 vs $4,805, p < .01). Similarly, SLE patients had decreased PPPM hospitalization costs ($3,192 vs $799, p = .04) and increased PPPM prescription costs ($905 vs $7,443, p < .01) after initiating RCI; the difference in overall PPPM healthcare costs was not statistically significant likely, due to small sample size.
This study, across a heterogeneous population of variable disease duration, described clinical and healthcare utilization and costs of RA and SLE patients initiating RCI in a real-world setting. We observed that patients receiving RCI had lower utilization and costs for medical services in both disease populations, which partially offset the increased prescription costs by 30% and 37%. Future research is needed to explore factors associated with RCI initiation and its impact on long-term outcomes.
评估开始使用促肾上腺皮质激素注射剂（RCI；H.P. Acthar Gel）治疗类风湿关节炎（RA）或系统性红斑狼疮（SLE）的患者的医疗资源利用（HRU）情况及成本。
在HealthCore综合研究数据库中识别出2006年7月1日至2015年4月30日期间年龄≥18岁且有≥2次RA或SLE诊断的患者。索引RCI日期为诊断后首次出现RCI的医疗或药房索赔的最早日期。使用描述性统计评估基线特征、开始使用RCI前后的HRU及成本。
本研究确定了180例开始使用RCI的RA患者（平均年龄 = 60岁，56%为女性）和29例SLE患者（平均年龄 = 45岁，90%为女性）。首次使用RCI的时间分别在初次RA和SLE诊断后的平均7.1个月和22.6个月。开始使用RCI后，RA患者的人均每月（PPPM）全因医疗成本（1881美元对682美元，p < 0.01）较开始使用前显著降低，这是由较低的PPPM住院成本（1579美元对503美元，p < 0.01）驱动的。由于较高的PPPM处方成本（869美元对4805美元，p < 0.01），总体PPPM医疗成本较高（2751美元对5487美元，p < 0.01）。同样，SLE患者开始使用RCI后PPPM住院成本降低（3192美元对799美元，p = 0.04），PPPM处方成本增加（905美元对7443美元，p < 0.01）；由于样本量较小，总体PPPM医疗成本的差异可能无统计学意义。
本研究针对疾病持续时间各异的异质性人群，描述了在现实环境中开始使用RCI的RA和SLE患者的临床及医疗资源利用情况和成本。我们观察到，在这两种疾病人群中，接受RCI治疗的患者医疗服务利用和成本较低，这部分抵消了分别增加30%和37%的处方成本。未来需要开展研究以探索与开始使用RCI相关的因素及其对长期结局的影响。
