For TNF-Experienced Patients with RA, Switching to Anti-TNF Saves Resources, Costs

VBCR - December 2015, Volume 4, No 6 - Rheumatoid Arthritis
Phoebe Starr

San Francisco, CA—For patients with rheumatoid arthritis (RA) who do not have an adequate response to anti–tumor necrosis factor (anti-TNF) therapy, switching to another anti-TNF appears to be the wiser choice from both a health and an economic standpoint.

A recent study presented at the annual meeting of the American College of Rheumatology (ACR) found that switching to an alternative anti-TNF was associated with fewer outpatient visits and lower medical and pharmacy costs compared with switching to a non-TNF biologic.

About 40% of all patients treated with an anti-TNF either fail to respond or lose responsiveness over time. There are no guidelines as to the best option for these patients. The present study found that switching to an anti-TNF biologic lowered annual healthcare costs by about $7000 and resulted in 22% fewer outpatient visits than did switching to non-TNF therapies.

According to the authors, “The current study findings are consistent with a previous study and represent real- world clinical practice, because new non-TNF agents, such as tocilizumab and tofacitinib, and a newer route of administration [abatacept sub Q] were included.”

“The current ACR guidelines do not have a preference for switching agents among anti-TNF–experienced RA patients. But the current study suggests that switching to anti-TNF biologics incurs lower outpatient resource utilization and lower pharmacy and medical costs than switching to non-TNF biologics among RA patients with an inadequate response to a prior anti-TNF treatment,” they wrote.

First author was Zheng-Yi Zhou of the Analysis Group, Inc, in Boston, MA, a paid consultant for AbbVie. The study was sponsored by AbbVie.

This economic analysis was undertaken to address the gap in the literature by including newer anti-TNF and other biologics to compare all-cause and RA-related healthcare costs and resource utilization between patients who discontinue their initial anti-TNF and subsequently switched to an a­lternative anti-TNF and those who switched to a non-TNF. The drugs included in the study were the anti-TNFs adalimumab, certolizumab, etanercept, golimumab, and infliximab, and the non-TNFs abatacept, anakinra, ri­tuximab, tocilizumab, and tofacitinib.

The Truven Health MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental Database (January 1, 2000, through December 1, 2013) were used in the analysis.

Patients enrolled in the trial had at least 2 RA diagnoses on 2 different dates during the study period and at least 1 claim for an anti-TNF biologic on or after the day of diagnosis. Additionally they had to have at least 6 months of continuous non–health maintenance organization enrollment before the index date when they first filled a prescription for a new biologic (either anti-TNF or non-TNF).

Two cohorts were defined: the anti-TNF cohort (n = 1169) and the non-TNF cohort (n = 408). Those in the anti-TNF switch cohort were about 2 years younger than those in the non-TNF cohort, and they had a lower burden of comorbidities. Fewer patients in the anti-TNF cohort had hypertension, diabetes, malignancy, and chronic obstructive pulmonary disease.

The most commonly used initial anti-TNF was etanercept (50%) and infliximab (39%) in the anti-TNF and non-TNF cohorts, respectively. Within the anti-TNF cohort, adalimumab was the most common switch biologic (45% of patients); within the non-TNF cohort, abatacept was the most common switch drug (62%).

During the 12-month study period, all-cause total costs were significantly lower for the anti-TNF cohort compared with the non-TNF cohort: $36,932 versus $44,566, reflecting a significant difference of $7045 per patient (P <.01).

Broken down by resource utilization, the anti-TNF cohort had lower all-cause medical costs and pharmacy costs than the non-TNF cohort: a difference of $3584 and $3966, respectively (P <.01 for both comparisons). RA- related total costs were also $4904 lower in the anti-TNF cohort compared with the non-TNF cohort (P <.01).

Reference

Zhou Z-Y, Griffith J, Ganguli A, et al. Economic burden of switching to an anti-tumor necrosis factor (anti-TNF) versus a non-tumor necrosis factor (non-TNF) biologic therapy among patients with rheumatoid arthritis. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 145.

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