SAT0720-HPR Longitudinal analysis of response, costs and resource use of patients with rheumatoid arthritis initiating biologic disease-modifying antirheumatic drugs (BDMARDS) in taiwan using the national health insurance research database
Authors: Q Shi, T Treuer, BC Wang, CL Gaich, C-H Lee, W-S Wu, W Furnback, K-J Li, C-H Tang
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis (RA) is an inflammatory disorder associated with a significant physical and psychological burden. Patients with RA experience a lower quality of life than patients without RA. This study utilizes Taiwan9s National Health Insurance Database (NHIRD) which is a claims-based database recording all interactions with the National Health Insurance (NHI) system. <h3>Objectives</h3> The objective of this study was to use the NHIRD to estimate the percentage of newly treated patients with inadequate response (IR) to biologic disease-modifying antirheumatic drugs (bDMARDs) as well as the costs and resources. <h3>Methods</h3> Data were from the catastrophic illness file within the NHIRD from 1/1/2009 to 12/31/2013. The index period spanned 2010 with a pre-index period consisting of the index date – 365 days, and patient follow-up was index date to 365 days post-index. Patients with a catastrophic illness card for RA were included in the study. Biologically-naïve patients included those who did not have a claim for a bDMARD or exclusion diagnoses in the pre-index period. Biologically-naïve patients with a bDMARD claim were indexed upon their first claim for a bDMARD during the index year. A validated algorithm was used to examine the rate of inadequate response in the biologically-naïve cohort of patients. Inadequate responders met one or more of the following criteria during their year of follow-up: low adherence (proportion of days covered &lt;0.80); switched to or added a second bDMARD; added a new conventional synthetic DMARD (csDMARD); received ≥1 glucocorticoid injection; or increased oral glucocorticoid dosing. All-cause mean annual direct costs and resource use were measured in the year of follow-up. Costs were converted from NT$ to EUR using 1 NT$ =0.03 EUR. <h3>Results</h3> A total of 818 biologically-naïve patients initiated a bDMARD and were included in the study. At 1 year of follow-up, 66.01% (n=540) were classified as bDMARD-IR, 31.54% (n=258) were classified as confirmed stable, and 2.44% (n=20) were of unknown response status. Mean annual total direct costs in the follow-up year were €14,669 and €12,867 for the confirmed stable and inadequate responder cohorts, respectively. Mean annual non-medication costs were 40.4% (€578) higher for the IR cohort, and mean annual medication costs were 17.2% (€2,379) higher for the confirmed stable cohort. IR patients had higher mean annual resource utilization in the follow-up year with increases in hospital admissions (0.46 vs. 0.1), hospital days (3.4 vs. 0.49), outpatient visits (42.50 vs. 37.66), and emergency department visits (0.51 vs. 0.3). <h3>Conclusions</h3> A significant proportion of patients with RA initiating a bDMARD for the first time showed an IR to their treatment within a year. Patients with an IR had increased resource utilization and higher non-medication costs than those with stable disease. This level of IR suggests an unmet need in the RA treatment paradigm. <h3>Disclosure of Interest</h3> Q. Shi Employee of: Eli Lilly &amp; Co., T. Treuer Employee of: Eli Lilly &amp; Co., B. Wang Consultant for: Eli Lilly &amp; Co., C. Gaich Employee of: Eli Lilly &amp; Co., C.-H. Lee Employee of: Eli Lilly &amp; Co., W.-S. Wu Employee of: Eli Lilly &amp; Co., W. Furnback Consultant for: Eli Lilly &amp; Co., K.-J. Li: None declared, C.-H. Tang: None declared