THU0555 HEALTHCARE COSTS IN PATIENTS WITH RHEUMATOID ARTHRITIS SWITCHING FROM THEIR FIRST CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG TO ANOTHER DISEASE-MODIFYING ANTIRHEUMATIC DRUG REGIMEN
Authors: R. K. Dore, J. Antonova, L. Chang, M. Gorritz, X. Wang, M. C. Genovese
Journal: Annals of the Rheumatic Diseases (2020)

Background: EULAR and ACR guidelines recommend a treat-to-target approach for rheumatoid arthritis (RA). For patients failing their first conventional synthetic disease-modifying antirheumatic drug (csDMARD), EULAR recommends switching to or adding another DMARD. Understanding treatment patterns, durability, and healthcare costs associated with treatments initiated after first csDMARD can help optimize treatment for these patients. Objectives: To describe real-world healthcare costs among patients with RA who failed their first csDMARD. Methods: The study included adults with ≥2 RA claims ≥30 days apart in a large US health claims database, who started a csDMARD regimen as the first DMARD then switched to or added another DMARD (index date [ID], 1/1/2012–3/31/2017). All patients had continuous enrollment 1-year before and ≥1 year after ID. Treatment duration was defined as number of days from initial treatment fill until loss of treatment persistence. Unadjusted mean total annualized per-patient-per-year (PPPY) healthcare costs while on treatment were compared via analysis of variance. A generalized linear model with gamma distribution and log link was used to compare total costs adjusted for pre-index costs, patient characteristics, and type of initiated treatment. Results: The study involved 7,816 patients (median age of 54 yrs, 74% female). Mean (standard deviation) duration of index therapy was 14.0 (12.6) months for patients overall (9.2 [10.1] for monotherapy vs 16.9 [13.1] for combination therapy, P &lt; .0001). Prior to switching, the unadjusted mean PPPY healthcare costs totaled $12,923: $13,923 for monotherapy vs $12,317 ( P = .0009) for combination therapy. Once switched, patients accrued unadjusted mean PPPY on-treatment healthcare costs of $30,742: $28,757 on monotherapy vs $31,943 ( P = .0003) on combination therapy. Figure 1 details pre- and post-ID unadjusted costs by index therapy. Patients on non-TNFi bDMARD monotherapy had higher adjusted total healthcare cost (cost ratio [CR] = 1.58, P = .0052) than the total cost on JAKi monotherapy, whereas csDMARD monotherapy (CR = 0.28, P &lt; .0001) and csDMARD + csDMARD(s) (CR = 0.26, P &lt; .0001) had lower total cost than the cost on JAKi monotherapy. Other factors impacting costs included baseline Charlson Comorbidity Index (CCI) = 2 or ≥3 vs CCI = 1 (CR = 1.14 and 1.25, respectively; both P &lt; .0001), baseline total (medical + pharmacy) healthcare costs (CR = 1.24, P &lt; .0001), and baseline opioid use (CR = 1.11, P &lt; .0001, Figure 2). Conclusion: Real-world data demonstrate short durability of available treatments initiated after first csDMARD. Among the initiated treatments, lowest total healthcare costs were associated with csDMARD, followed by JAKi, then TNFi, and finally non-TNFi bDMARD. Disclosure of Interests: Robin K Dore Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Jenya Antonova Employee of: Gilead Sciences. Inc., Lawrence Chang Consultant of: Gilead Sciences, Inc., Magdaliz Gorritz Consultant of: Gilead Sciences, Inc., Xin Wang Consultant of: Gilead Sciences, Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme