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RA is Costly, Especially When Biologic DMARDs Are Used

Discussion in 'Immunology and Rheumatology' started by Dr.Scorpiowoman, Jan 14, 2018.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    But biologic DMARDs themselves are not responsible for increased costs

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    The annual cost of direct medical care for a patients with rheumatoid arthritis (RA) is $12,509, with 30% of the total costs attributable to RA, according to a meta-analysis of cost-of-care studies. Among RA patients treated with biologic disease-modifying antirheumatic drugs (DMARDs), the total direct medical costs were triple those for the typical RA patient, and the cost of RA care was more than half of all direct medical costs, found researchers from Tufts University and Harvard Medical School in Boston.

    "These findings suggest that costs associated with RA are in line with those for other prominent chronic diseases," wrote Andrew Hresko of Tufts and colleagues. They noted that the annual total direct cost of care (using 2015 dollars) exceeds $14,000 for patients with diabetes and $23,000 for patients with multiple sclerosis, and ranges from $4,000 to $13,000 for patients with ulcerative colitis and $1,600 to $10,800 for patients with chronic obstructive pulmonary disease.

    "Our findings also suggest that the burden of RA patients on the U.S. healthcare system may become outsized compared to the disease's relatively small prevalence and compared to patients with these other chronic conditions as more patients use biologic DMARDs in the future," the researchers wrote in Arthritis Care & Research.

    A systematic literature review and meta-analysis were conducted to assess the costs associated with RA since the introduction of biologic DMARDs in 1999. Twelve papers met the authors' selection criteria. Four studies included only RA patients who used biologic DMARDs and eight included RA patients treated with biologic DMARDs or other therapies.

    Among the eight studies that included all RA patients regardless of their treatment, the annual total cost of care ranged from $3,266 to $25,260, with the lowest estimate in a population of Medicaid enrollees and the highest in a Medicare population. The $3,266 finding was an outlier (obtained in a Medicaid population), the authors noted, being only 28% of the next lowest estimate. The total cost of care ranged from $11,554 to $12,904 among studies comprised of privately insured patients and $21,445 to $25,260 in studies of Medicare patients.

    Meta-analysis of studies that included patients regardless of treatment found the annual total cost of care to be $12,509 (95% CI $7,451-21,001). When the lowest estimate was removed, the total cost of care did not change substantially ($12,458, 95% CI 7,381-21,025).

    Among the four studies restricted to RA patients using biologic DMARDs, the annual total cost of care ranged from $26,469 to $52,837. Meta-analysis found the annual total cost of care in this population to be $36,053 (95% CI $32,138-40,445).

    Estimates for the annual cost for RA-specific care ranged from $2,437 to $7,849, with the lowest estimate arrived at when modeling the general U.S. population and the highest in models of of Medicaid enrollees. Meta-analysis of RA patients using any treatment showed that the annual cost for RA-specific care was $3,725 (95% CI $2,408-5,768), representing 30% of total costs for all care.

    Estimates of RA-specific costs in studies limited to patients using biologic DMARDs ranged from $16,716 to $22,445. These estimates were based on claims databases of privately insured working-age adults. Meta-analysis found the annual RA-specific cost within this population to be $20,262 (95% CI $17,480-23,487), representing 56% of total costs for all care.

    "In considering the observed costs, it is interesting to note that patients that use biologic DMARDs had increased costs over typical RA patients," Hresko and colleagues wrote. "Additionally, biologic DMARD use had a larger incremental effect on RA-specific costs (444% increase) than on total direct medical costs (188% increase). However, in both cases the increment was below the total cost of biologic DMARDs themselves. This suggests that either the use of biologic DMARDs may be associated with lower total non-drug direct medical costs or that the patients who receive biologic DMARDs have fewer comorbid conditions."

    Limitations, the authors said, include the different methodologies of the studies reviewed and the lack of individual patient-level data. In addition, the indirect costs of RA (i.e., lost work, caregiver costs) were not assessed.

    "Without considering the health effects, benefits, and risks, the current analysis cannot comment on whether specific treatments are of value," the team concluded. "Cost-effectiveness analyses comparing different treatment strategies for RA are ongoing and will provide useful information."

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