POS1416 THE IMPACT OF NON-PERSISTENCE ON RESOURCE UTILIZATION COSTS IN IMMUNE-MEDIATED RHEUMATIC DISEASES
Authors: N. Carballo, E. Garcia-Alzorriz Morral, O. Ferrández-Quirante, C. Perez-Garcia, M. E. Navarrete-Rouco, X. Duran, J. Monfort, F. Cots, S. Grau
Journal: Annals of the Rheumatic Diseases (2021)

Background: Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic progressive immune-mediated rheumatic diseases (IMRD) that can cause a progressive disability and joint deformation and thus can impact in healthcare resource utilization (HCRU) and costs. Objectives: To describe the HCRU and treatment costs in IMRD patients initiating subcutaneous tumour necrosis factor-alpha inhibitors (SC-TNFi) therapy, based on treatment persistence. Methods: Retrospective cohort study including all naïve patients initiating SC-TNFi therapy for IMRD from 2015-2018 in a tertiary university hospital. Patients were divided into two cohorts: persistent and non-persistent. Treatment persistence was estimated as the duration of time from SC-TNFi therapy initiation to discontinuation during one year of follow-up. SC-TNFi therapy and HCRU costs (outpatient care, rheumatology specialized outpatient care, inpatient care, emergency care, laboratory testing and other non- biological therapies) were calculated one year before and after initiation of SC-TNFi and compared between persistence and non-persistence groups. Results: 110 patients were identified. Baseline characteristics: Non-persistent cohort (n=25) versus Persistent cohort (n=85): median age 48.6(12.7) vs 47.3(15.4) (p=0.692). Female (n=12;48%) vs (n=49;57.6%) (p=0.493). Race: Caucasian (n=22;88%), Asiatic (n=3;12%), Other (n=0;0%) vs Caucasian (n=75;88.2%), Asiatic (n=5;5.9%), Other (n=5;5.9%) (p=0.351).IMRD: RA (n=14;56%),PsA (n=2;8%), AS (n=4;16%), other spondyloarthropathy (n=5;20%) vs RA (n=34;40%),PsA (n=11;12.9%), AS (n=24;28.3%), other spondyloarthropathy (n=16;18.8%) (p=0.470). SC-TNFi therapy: adalimumab (n=4;16%), etanercept commercial (n=4;16%), etanercept biosimilar1 (n=5;20%), etanercept biosimilar2 (n=5;20%), golimumab (n=5;20%), certolizumab (n=2;8%) vs adalimumab (n=22;25.9%), etanercept commercial (n=11;12.9%), etanercept biosimilar1 (n=7;8.3%), etanercept biosimilar2 (n=10;11.8%), golimumab (n=24;28.2%), certolizumab (n=11;12.9%) (p=0.398). Overall cost of SC-TNFi treatment: Non-persistent 11218.81€ (6444.32), persistent 10470.19€ (3465.48); p= 0.658. Table 1. HCRU costs Non-persistent(n=25) Persistent(n=85) Total(n=110) P HCRU costs 12 months prior to SC-TNFi initiation,€(SD) Outpatient care 243.48(828.86) 87.17(293.61) 122.70(471.20) 0.204 Rheumatology outpatient care 216.39(169.88) 174.79(101.06) 184.24(120.55) 0.224 Inpatient care 500.41(1542.93) 170.34(846.47) 245.36(1046.74) 0.571 Emergency care 37.77(66.00) 39.30(83.16) 38.95(79.31) 0.850 Laboratory testing 376.12(195.59) 388.20(207.07) 385.46(203.70) 0.458 Other non-biological therapies 10.77(39.83) 36.79(250.55) 30.88(221.01) 0.803 Total 1384.94(1816.17) 896.60(1247.60) 1007.59(1402.87) 0.299 HCRU costs 12 months post SC-TNFi initiation,€(SD) Outpatient care 106.11 (172.85) 76.67 (112.90) 83.36 (128.67) 0.682 Rheumatology outpatient care 327.29(170.10) 195.58(100.05) 225.52(130.99) &lt;0.001 Inpatient care 89.35(446.77) 80.86(466.54) 82.79(460.11) 0.969 Emergency care 89.14(171.89) 36.06(106.23) 48.12(125.31) 0.198 Laboratory testing 182.14(128.62) 146.86(141.48) 154.88(138.89) 0.061 Other non-biological therapies 3859.80(4043.86) 25.89(116.05) 897.24(2493.21) &lt;0.001 Total 4653.84(4269.61) 561.93(682.14) 1491.91(2709.23) &lt;0.001 Conclusion: - Non-persistence was observed in less than a quarter of the patients. - No differences in the costs of SC-TNFi treatment were observed between the persistent and non-persistent groups, leading us to believe that persistence may not be associated with SC-TNFi costs offsets for patients with IMRD. - During the period post SC-TNFi initiation, the costs of rheumatologic outpatient care and treatment with other non-biological therapies as well as total costs were statistically significantly lower in the persistent cohort. These results suggest that persistence may be associated with HCRU cost savings for IMRD patients. Disclosure of Interests: None declared