Economic Burden of Patients With RA After Inadequate Response to Targeted Therapy


Inadequate response to targeted immunomodulators for rheumatoid arthritis (RA) may lead to significantly higher economic burden, including higher health care resource utilization, according to a study published in the Journal of Managed Care & Specialty Pharmacy (April 2018;24[4]:344-352).

Targeted immunomodulators—including biologic disease-modifying antirheumatic drugs (DMARDs) and JAK/STAT inhibitors—have demonstrated effectiveness in patients with RA. However, some patients fail to respond or lose response over time to targeted immunomodulators.

Vibeke Strand, MD, division of immunology and rheumatology, Stanford University School of Medicine, and colleagues designed a study to estimate the real-world prevalence of patients with RA and inadequate responses to an initial targeted immunomodulator in the United States. Researchers also assessed the direct and indirect economic burden of these patients (n = 5013) compared with treatment responders (n = 2527). Administrative claims data from 1999 through 2014 from a large private-insurer database were utilized. All-cause and RA-related health care resource utilization and costs, work loss, and indirect costs during the study period were compared for responders vs non-responders.

Among the total patient population, 407 responders and 723 non-responders had work-loss data, researchers noted.

After adjusting for baseline covariates, Dr Strand and colleagues found that non-responders had significantly higher health care resource utilization, including inpatient admissions (incidence rate ratio [IRR] = 1.94), outpatient visits (IRR = 1.19), ED visits (IRR = 1.53), and number of prescriptions fills (IRR = 1.09). Non-responders also had significantly higher adjusted all-cause ($12,868 vs $9,621, respectively) and RA-related ($5740 vs $4495, respectively) medical costs compared with responders.


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Additionally, researchers found that non-responders had significantly more days of work lost compared with responders (22.1 vs 16.7 days, respectively; IRR = 1.21) as well as higher indirect costs ($3548 vs $2890).

"A large portion of patients with RA had inadequate responses to their initial targeted immunomodulator therapy with significantly higher economic burden, including higher health care resource utilization, medical costs, and indirect costs due to work loss, compared with targeted immunomodulator therapy responders," Dr Strand and colleagues concluded.—Zachary Bessette