title: Economic Burden of Switching to a Non-Tumor Necrosis Factor Inhibitor Versus a Tumor Necrosis Factor Inhibitor Biologic Therapy among Patients with Rheumatoid Arthritis.
abstract: The objective of this study was to examine healthcare resource utilization (HRU) and costs associated with switching to another tumor necrosis factor alpha inhibitor (TNFi) therapy versus a non-TNFi therapy among patients with rheumatoid arthritis (RA) discontinuing use of an initial TNFi biologic therapy.
  
  
  
  Patients with ≥2 RA diagnoses who used ≥1 TNFi on or after their initial RA diagnosis were identified in a US employer-based insurance claims database. Patients were selected based on ≥1 claim of another TNFi or a non-TNFi biologic therapy (occurring after 2010, and within 30 days before to 60 days after discontinuation of the initial TNFi), and continuous insurance ≥6 months before (baseline period) and ≥12 months after the switch date (study period). Patient demographic and clinical characteristics were measured during the baseline period. All-cause and RA-related HRU and costs were analyzed during the 12-month study period using multivariable regression analysis controlling for baseline characteristics and selected comorbidities.
  
  
  
  Of the 1577 patients with RA that switched therapies, 1169 patients used another TNFi and 408 patients used a non-TNFi biologic. The most commonly used initial TNFi treatments were etanercept (50%) and adalimumab (34%) among the TNFi cohort, and infliximab (39%) and etanercept (28%) among the non-TNFi cohort. The TNFi cohort had significantly fewer outpatient visits [all-cause: 23.01 vs. 29.77 visits/patient/year; adjusted incidence rate ratio (IRR) = 0.78, P < 0.001; RA-related: 7.42 vs. 13.58; adjusted IRR = 0.58, P < 0.001] and rheumatologist visits (all-cause: 4.01 vs. 6.81; adjusted IRR = 0.66, P < 0.001; RA-related: 3.23 vs. 6.40; adjusted IRR = 0.58, P < 0.001) than the non-TNFi cohort. All-cause total costs were significantly lower for patients who switched to another TNFi instead of a non-TNFi therapy ($36,932 vs. $44,566; adjusted difference = $7045, P < 0.01), as were total RA-related costs ($26,973 vs. $31,735; adjusted difference = $4904, P < 0.01).
  
  
  
  Adult patients with RA discontinuing TNFi therapy who switched to an alternative TNFi incurred lower healthcare costs than patients who switched to a non-TNFi biologic.
  
  
  
  AbbVie, Inc.
authors.affiliation: Analysis Group, Inc., New York, NY, USA. jenny.zhou@analysisgroup.com.
authors.forename: Zheng-Yi
authors.identifier: 0000-0001-9014-8479
authors.initials: ZY
authors.lastname: Zhou
authors.affiliation: AbbVie, Inc., North Chicago, IL, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Griffith
authors.affiliation: Analysis Group, Inc., Los Angeles, CA, USA.
authors.forename: Ella Xiaoyan
authors.initials: EX
authors.lastname: Du
authors.affiliation: AbbVie, Inc., North Chicago, IL, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chin
authors.affiliation: Analysis Group, Inc., Los Angeles, CA, USA.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Betts
authors.affiliation: AbbVie, Inc., North Chicago, IL, USA.
authors.forename: Arijit
authors.initials: A
authors.lastname: Ganguli
mesh_terms: D000068879:Adalimumab / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics; D001691:Biological Therapy / Q000191:economics / Q000379:methods; D017281:Cost of Illness; D016208:Databases, Factual / Q000706:statistics & numerical data; D057915:Drug Substitution / Q000191:economics / Q000379:methods; D000068800:Etanercept / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Biologic therapy switching; Economic burden; Healthcare costs; Healthcare utilization; Non-tumor necrosis factor inhibitor; Rheumatoid arthritis; Rheumatology; Tumor necrosis factor alpha inhibitor