Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Direct Costs in Newly Diagnosed and Established Rheumatoid Arthritis Patients, and Comparison with Non-Rheumatoid Arthritis Controls in An Insurance Claims Database.
Crane1, Martin M., Manson2, Stephanie, Juneja3, Maneesh, Allen1, Jeffery, Kurrasch4, Regina H., Chu5, Myron E., Quattrocchi2, Emilia
GlaxoSmithKline, Research Triangle, NC
London, United Kingdom
GlaxoSmithKline, Stockley Park, United Kingdom
Medicines Development, GlaxoSmithKline, King of Prussia, PA
Medicines Development GlaxoSmithKline, King of Prussia, PA
Although DMARDs (disease modifying anti-rheumatic drugs) remain a mainstay of rheumatoid arthritis (RA) therapy, the cost structure of treating these patients has significantly changed, often with higher direct medical costs, since introduction of biologics. We sought to quantify these costs in different RA populations.
An incident (newly diagnosed in 2006) and a prevalent RA (end of 2005) cohort based on two Outpatient(OP)/Inpatient (IP) visits >30 days apart were identified by ICD9 codes from the Pharmetrics Choice administrative claims database and followed through 9/2008. An "aggressive" subset of incident patients was defined based on >8 OP/IP visits in the first 12 months. Annualized direct costs per patient were determined for medication, OP (includes laboratory and imaging), and IP (includes ER), based on actual amounts reimbursed to providers; co-pays were also available. Costs are presented as mean (SD), adjusted for inflation. A non-RA cohort, matched by age, gender and duration in the database was selected for comparison.
There were 2,136 incident (265 in the aggressive subset) and 19,805 established patients (incidence 0.07%; prevalence 0.65%). Between years 1 and 2, total annualized costs per incident patient increased from $4,703 ($8,339) to $5,137 ($9,273). Medications, OP and IP costs comprised 66%, 24% and 10% respectively of the total in Year 1 and 78%, 14% and 8% in Year 2. For the aggressive subgroup, the total cost per patient in Year 1 was $8,804 ($9,268) and $10,803 ($12,557) inYear 2 due more rapid and extensive uptake of biologics (50% by end of Year 2 vs 22% in the non-aggressive group); co-pays in the aggressive patients averaged $1,200/year vs $600 in the non-aggressive patients. During the total study period (median follow-up 2.3 yrs), 71.5% of incident patients were not prescribed an anti-TNF and the total cost over follow-up was $1,573 ($3,389); of those who were prescribed an anti-TNF, 66.7% continued with the original prescription, 21.0% switched to a second, and 4.9% switched to a third with total costs of $13,224 ($9,066), $17,059 ($10,891), and $18,691 ($9,330), respectively. In established patients,total annualized costs increased with duration of documented RA up to four years after first known date of diagnosis: in 2006, costs increased from $5,508 ($9,299) in patients with duration up to one year to $8,653 ($14,423) for patients with duration up to four years. Prevalent RA patients compared to the non-RA group had higher rates of cardiovascular disease (20% vs 14%), anemia (29% vs 15%) and infections (91% vs 84%) and greater total medical costs from 2005-Sept/2008 ($15,276 ($18,683) vs $5,753 ($10,642)); costs in all categories (medications, OP, IP, ER, lab, imaging) were greater in the RA cohort, especially medication [$7,128 ($9,633) vs $1,499 ($3,299)].
Medications accounted for the highest proportion of direct costs in incident RA patients and costs for those prescribed biologics were an order of magnitude higher than those receiving conventional DMARDs. Total direct costs increased with duration of disease in established RA patients up to at least four years post-diagnosis. RA is an expensive disease due, in large part, to medication costs.
To cite this abstract, please use the following information:
Crane, Martin M., Manson, Stephanie, Juneja, Maneesh, Allen, Jeffery, Kurrasch, Regina H., Chu, Myron E., et al; Direct Costs in Newly Diagnosed and Established Rheumatoid Arthritis Patients, and Comparison with Non-Rheumatoid Arthritis Controls in An Insurance Claims Database. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :916