Bristol Myers Squibb, Lawrence Township, NJ, USA.
Avalere Health, Washington, DC, USA.
J Med Econ. 2021 Jan-Dec;24(1):299-307. doi: 10.1080/13696998.2021.1881525.
This study evaluated infection-related hospitalization risk and cost in tumor necrosis factor inhibitor (TNFi)-experienced and targeted DMARD (tDMARD) naïve rheumatoid arthritis (RA) patients that were treated with abatacept, TNFi, or other non-TNFi.
This retrospective study used 100% Medicare Fee-for-Service claims to identify patients ≥65 age, diagnosed with RA, and were either 1) TNFi-experienced, who switched from a TNFi to another tDMARD (subsequent tDMARD claim served as index), or 2) tDMARD naïve (first therapy claim served as index), who initiated either abatacept, TNFi, or non-TNFi as their first tDMARD, between 2010 and 2017. Follow-up ended at the date of disenrollment, death, end of study period, or end of index treatment, whichever occurred first. Infection-related hospitalizations included pneumonia, bacterial respiratory, sepsis, skin and soft tissue, joint or genitourinary infections. A Cox proportional hazard model and two part generalized linear model were developed to estimate adjusted infection-related hospitalization risk and costs. Costs were normalized to per-patient-per-month (PPPM) and inflated to 2019 US$.
The infection-related hospitalizations rate was lower during follow-up than during baseline periods for abatacept users, but was reversed for both TNFi and other non-TNFi users in both TNFi-experience and tDMARD naïve ( value < .001 based on Breslow-Day test for homogeneity of odds ratios). Infection-related hospitalization PPPM cost was significantly lower in abatacept treated patients compared to TNFi (TNFi-experienced: by $74; tDMARD naïve: $42) and other non-TNFi (TNFi-experienced: by $68; tDMARD naïve: $60). The adjusted infection-related hospitalization risk was significantly higher for RA patients treated with TNFi (TNFi-experienced HR: 1.48; 95% CI: 1.26-1.75, < .0001; tDMARD naïve HR:1.59; 95% CI: 1.43-1.77, < .0001) and other non-TNFi (TNFi-experienced HR:1.46; CI:1.28-1.66; tDMARD naïve HR:1.63; 95% CI: 1.44-1.83) than with abatacept.
RA Medicare Fee-For-Service beneficiaries who either switched or initiated abatacept have a lower infection-related hospitalization risk and cost compared to patients who switched to or initiated other tDMARDs.
本研究评估了肿瘤坏死因子抑制剂（TNFi）经验丰富和靶向 DMARD（tDMARD）初治类风湿关节炎（RA）患者在接受阿巴西普、TNFi 或其他非 TNFi 治疗时与感染相关的住院风险和费用。
本回顾性研究使用了 100%的医疗保险按服务收费数据，以确定≥65 岁、诊断为 RA 且符合以下条件的患者：1）TNFi 经验丰富，从 TNFi 转换为另一种 tDMARD（后续 tDMARD 索赔作为索引），或 2）tDMARD 初治（首次治疗索赔作为索引），在 2010 年至 2017 年期间首次接受阿巴西普、TNFi 或非 TNFi 作为其第一种 tDMARD。随访在退保、死亡、研究结束或索引治疗结束时结束，以先发生者为准。与感染相关的住院治疗包括肺炎、细菌性呼吸道感染、败血症、皮肤和软组织、关节或泌尿生殖道感染。使用 Cox 比例风险模型和两部分广义线性模型来估计调整后的感染相关住院风险和费用。费用按每位患者每月（PPPM）进行标准化，并换算为 2019 年美元。
与 TNFi 经验丰富和 tDMARD 初治患者的基线期相比，阿巴西普治疗患者的感染相关住院治疗率在随访期间较低，但 TNFi 和其他非 TNFi 治疗患者的情况正好相反（基于 Breslow-Day 检验，比值比的同质性 < 0.001）。与 TNFi（TNFi 经验丰富：74 美元；tDMARD 初治：42 美元）和其他非 TNFi（TNFi 经验丰富：68 美元；tDMARD 初治：60 美元）相比，阿巴西普治疗患者的感染相关住院治疗费用明显降低。与 TNFi（TNFi 经验丰富 HR：1.48；95%CI：1.26-1.75，< 0.0001；tDMARD 初治 HR：1.59；95%CI：1.43-1.77，< 0.0001）和其他非 TNFi（TNFi 经验丰富 HR：1.46；CI：1.28-1.66；tDMARD 初治 HR：1.63；95%CI：1.44-1.83）相比，RA 医疗保险按服务收费受益人的 TNFi 经验丰富和 tDMARD 初治患者的感染相关住院治疗风险更高。
与切换或开始使用其他 tDMARD 的患者相比，切换或开始使用阿巴西普的 RA 医疗保险按服务收费患者的感染相关住院治疗风险和费用较低。
