Financial Burden of ACPA Status in Patients With Rheumatoid Arthritis

A recent comparative effectiveness study examined the relationship of anticitrullinated protein antibody (ACPA) status and accrued economic burden for patients with rheumatoid arthritis, published in the Journal of Managed Care & Specialty Pharmacy (online August 14, 2017; doi:10.18553/jmcp.2017.17129).


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ACPAs are biomarkers commonly associated with early and quickly-progressing rheumatoid arthritis, including more severe disease and joint damage. Testing for ACPA status has become a routine practice for rheumatoid arthritis diagnosis and prognosis. Prior research has shown that ACPA-positive status directly impacts treatment efficacy, but it is unclear whether ACPA status affects the economic burden of patients.

Jason Shafrin, PhD, Precision Health Economics (Los Angeles, CA), and colleagues conducted a study to determine if the financial burden of rheumatoid arthritis varies by patient ACPA status. Researchers pooled data from 42,285 patients with rheumatoid arthritis incidence cases from 2010-2015 who had an anticyclic citrullinated peptide (anti-CCP, a surrogate of ACPA) antibody test within 6 months of diagnosis.

The primary outcome of the study was disease-related medical expenditures, defined as the sum of payer- and patient-paid amounts for all inpatient or outpatient claims. Secondary outcomes included health care utilization metrics, such as treatment with a disease-modifying antirheumatic drug (DMARD) and physician visits.

Among the patient sample, 859 patients had a linked electronic medical record and a reported anti-CCP test result. ACPA-positive status was noted in 24.7% (n = 212) of such patients. When comparing with ACPA-negative patients, researchers found that ACPA-positive patients were more likely to use either conventional DMARDs (71.2% vs 49.6%; P < .001) or biologic DMARDs (20.3% vs 11.8%; P <.001) within the first year of diagnosis, along with more physician visits (5.58 vs 3.91 times per year; P < .001).

Researchers reported that annual disease-associated total expenditures were $7941 for ACPA-positive patients and $5243 for ACPA-negative patients. Rheumatoid arthritis-associated medical expenditures were $4380 for ACPA-positive patients and $3427 for ACPA-negative patients. DMARD expenditures were $3560 and $1817, respectively.

Authors of the study concluded that rheumatoid arthritis-related financial burden is significantly higher for patients with are ACPA-positive compared with those who are ACPA-negative. “Providers may wish to inform patients diagnosed with ACPA-positive rheumatoid arthritis about the likely future disease and economic burden in hopes that both stakeholders can be more proactive in addressing them,” they wrote.—Zachary Bessette