https://orcid.org/0000-0002-7948-9827
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ABSTRACT
Background
Previous U.S. economic burden estimates for rheumatoid arthritis (RA) varied from $85.6 to $148.1 billion annually. However, these estimates do not reflect comparative amounts spent on RA treatment options in addition to other medical expenditures. Therefore, this study’s goal was to comparatively analyze the overall economic burden of U.S. patients treated for RA using conventional disease-modifying antirheumatic drugs (DMARDs) versus TNF alpha biologic DMARDs.
Research Design and Methods
This retrospective observational study analyzed Medical Expenditure Panel Survey Household Component data from 2016 to 2018. Healthcare utilization, total medical expenditures, and out-of-pocket expenditures were compared between RA medication groups.
Results
Three hundred twenty-five adult RA patients experiencing 603 RA-related events, including at least one medical visit, were identified. Rheumatic arthritis-attributable medical expenditures among patients prescribed DMARDs were $11.4 billion. Average total medical expenditures were significantly higher for the TNF alpha biologic group $26,216.67 (95% CI: $19,502.84–$32,930.5) versus $5,388.52 (95% CI: $2,768.25–$8,008.79) for the conventional DMARD group (p < 0.001).
Conclusions
RA patients receiving TNF alpha biologics experienced significantly higher total medical and out-of-pocket expenditures; however, they experienced fewer or no occurrences of high-cost drivers of healthcare utilization compared to patients receiving conventional DMARDs.
Plain Language Summary
This study shows that rheumatoid arthritis (RA) patients with biologic-containing disease-modifying antirheumatic drugs (DMARDs) encountered significantly higher total medical expenditures as well as out-of-pocket (OOP) expenditures versus those with conventional DMARDs. The average total medical expenditures were $26,216.67 in the tumor necrosis factor (TNF) alpha biologic group and $5,388.52 in the conventional DMARD group. However, even with higher total medical expenditures, data suggests the TNF alpha biologic group experienced fewer emergency room visits, less home health services, and no hospitalizations compared to the conventional DMARD group.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Q Ding and D Shiltz collaborated in study conception and design. Q Ding had full access to the data and was responsible for the data analyses. Q Ding, D Shiltz, and D Hossami were involved in data interpretations. Q Ding, D Shiltz, D Hossami, and A Konieczny were involved in drafting the article, reviewing, and revising it critically for important intellectual content. The final version of the manuscript was approved by all the authors for publication.
Previous presentation
A poster of ‘The TOTAL Medical Expenditure and out-of-Pocket Expenditure of Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Patients in the United States,’ was presented on International Society for Pharmacoeconomics and Outcomes (ISPOR) Annual Meeting 2021, Virtual, (17 May 2021).