AB1344-HPR POOLED ANALYSIS OF ASSOCIATION BETWEEN ABATACEPT OR OTHER TARGET DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (TDMARD) AND TYPE 2 DIABETES MELLITUS (T2DM)-RELATED HEALTHCARE RESOURCE UTILIZATION (HCRU) AND COSTS IN TNFI-NAÏVE RHEUMATOID ARTHRITIS (RA) PATIENTS WITH T2DM
Authors: X. Han, Q. Xia, Y. Bao, V. Patel, A. Roy, V. Rajagopalan, F. Lobo
Journal: Annals of the Rheumatic Diseases (2020)

Background: Limited information is available on the impact of target disease-modifying anti-rheumatic drugs (tDMARD) on patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM). Objectives: The objective was to compare T2DM-related healthcare resource utilization (HCRU) and cost for TNF inhibitors (TNFi)-naive patients pooled from two commercial databases with RA and T2DM receiving abatacept, other non-TNFi, or TNFi. Methods: A retrospective, observational study was conducted with MarketScan and PharMetrics (January 2008-September 2018). The study population included TNFi-naïve adult patients with RA and T2DM newly initiating abatacept, TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or other non-TNFi (tocilizumab, anakinra, sarilumab, rituximab, tofacitinib). Date of tDMARD initiation was the index date. Patients had ≥2 RA diagnoses separated by ≥7 days, ≥1 T2DM diagnosis, and had ≥12 months of pre-index continuous enrollment. Follow-up ended at the end of patient insurance enrollment, study period or index treatment. T2DM-related HCRU and costs including inpatient stay, outpatient visits, ER visits, and pharmacy use were measured on a per-patient-per-month (PPPM) basis (2018 USD). Patients treated with abatacept were matched to TNFi and non-TNFi cohorts separately by propensity score adjusted with patients baseline comorbidities, HCRU, and costs. Results: A total of 16,236 patients meeting criteria were identified. Most patients were female (74.3%), and the overall average age of 55.4 years (Table 1). After matching, 850 pairs of abatacept vs non-TNFi patients, and 1,096 pairs of abatacept vs TNFi patients were included in the adjusted results. Patients initiating abatacept had $144 lower adjusted T2DM-related costs as compared to non-TNFi and $79 lower costs than TNFi cohorts (Table 2). Table 1. Patient Characteristics Abatacept n=1,134 Non-TNFi n=1,353 TNFi n=13,749 Total N=16,236 Age, mean years (SD ) 58.5 (11.3) 57.7 (11.2) 54.9 (10.6) 55.41 (10.7) Gender, female, n (% ) 936 (82.5) 993 (73.4) 10,142 (73.8) 12,071 (74.3) CCI, mean (SD ) 2.2 (1.4) 2.3 (1.4) 1.8 (1.1) 1.89 (1.14) DCSI, n (% ) Cardiovascular 361 (31.8) 406 (30.0) 2,500 (18.2) 3,267 (20.1) Neuropathy 294 (25.9) 374 (27.6) 3,161 (23.0) 3,829 (23.6) Nephropathy 146 (12.9) 193 (14.3) 1,151 (8.4) 1,490 (9.2) PVD 131 (11.6) 155 (11.5) 874 (6.4) 1,160 (7.1) Retinopathy 103 (9.1) 119 (8.8) 922 (6.7) 1,144 (7.0) Cerebrovascular 74 (6.5) 102 (7.5) 620 (4.5) 796 (4.9) Metabolic 9 (0.8) 20 (1.5) 141 (1.0) 170 (1.0) CCI: Charlson comorbidity index; DCSI: diabetes complications severity index; PVD: peripheral vascular disease. Table 2. Adjusted T2DM-related HCRU and Costs after Propensity Score Matching Abatacept n=850 Non-TNFi n=850 Diff (ABA- Non-TNF ) Abatacept n=1,096 TNFi n=1,096 Diff (ABA- TNF ) T2DM-related HCRU (per 1000 Patients per Month ) Number of Hospitalizations 13.9 20.4 -6.5* 12.6 14.9 -2.3* Number of ER Visits 22.0 16.1 5.9* 18.4 16.3 2.0* Number of Outpatient Visits 311 334.8 -23.7* 299.3 286.9 12.4 T2DM-related Costs (PPPM $ ) Inpatient Costs 507 535 -28 413 475 -62 ER Costs 27 17 10* 22 25 -3 Outpatient Costs 190 323 -133 186 170 16* Pharmacy Costs 107 100 7* 97 128 -31 Total Costs 831 975 -144 719 798 -79* *P&lt;0.05 Conclusion: TNFi-naive RA patients with T2DM newly initiating abatacept had lower adjusted rates of T2DM-related hospitalizations compared to patients who initiated a non-TNFi or a TNFi. Total costs were lower among patients initiating abatacept vs. patients who initiated a non-TNFi or a TNFi. Findings suggest that initial abatacept among TNFi-naïve patients may be able to reduce healthcare utilization arising from T2DM complications and reduce T2DM-related costs in RA patients. Disclosure of Interests: Xue Han Employee of: BMS, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Ying Bao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Vardhaman PATEL Employee of: Bristol Myers Squibb, Amrina Roy Employee of: Mu-Sigma, Varshini Rajagopalan Employee of: Mu-Sigma, Francis Lobo Shareholder of: Bristol-Myers Squibb (US), Employee of: Bristol-Myers Squibb (US)