In the Journals

Medical costs for RA three-fold higher among biologic DMARD users

Andrew Hresko
Daniel Solomon

Medical costs for patients with rheumatoid arthritis treated with biologic disease-modifying antirheumatic drugs are nearly three times higher than costs for patients who use any treatment regimen, according to findings published in Arthritis Care and Research.

“Rheumatoid arthritis is an expensive condition, both in its health effects and the treatments used to manage the illness,” Daniel Solomon, MD, MPH, from the Brigham and Women’s Hospital and Andrew Hresko, BA, from the Tufts University School of Medicine, told Healio Rheumatology. “In the U.S., almost 50% of patients receive expensive targeted therapies, thus it represents an important illness to examine for the cost of care. Additionally, RA is a condition in which there has been significant early adoption of biologic drugs and thus can be a model of how adoption of these drugs in other diseases could affect their cost as well.”

To analyze the direct medical costs related to RA care in the United States since the advent of biologic DMARDs in the late 1990s, the researchers conducted a systematic literature review. After identifying 541 potentially relevant studies, the researchers narrowed their scope to 12 published papers that met their criteria — printed in English with a focus on a U.S. population, analysis of post-1999 data and the inclusion of total direct costs of RA treatment.

Two reviewers independently collected data from the studies, before the researchers analyzed the methods and quality of each. The researchers determined total and RA-related medical costs through random effects meta-analysis, with patients on Medicare and those using biologic disease modifying anti-rheumatic drugs identified as subgroups of interest.

According to the researchers, the estimated total medical cost for all patients with RA is $12,509 (95% CI, $7,451 to $21,001). For all patients treated with biologic disease modifying anti-rheumatic drugs, the total costs were $36,053 (95% CI, $32,138 to $40,445). Among patients using any treatment, RA-related costs accounted for $3,723 (95% CI, $2,408 to $5,762). However, among those treated with biologic disease modifying anti-rheumatic drugs, RA-related costs amounted to $20,262 (95% CI, $17,480 to $23,487).

“We found that the costs for treating rheumatoid arthritis were significantly impacted when biologic DMARDs were chosen,” Solomon and Hresko told Healio Rheumatology. “We have all observed the potential benefits of targeted biologic DMARDs — however, they come with a very large price tag. The clinical significance is to recognize that not only do biologic DMARDs come with a significant price tag to society, but rheumatoid arthritis does as well.”

The researchers also noted that “the burden of RA patients on the U.S. health care system may become outsized compared to the disease’s relatively small prevalence, and compared to patients with other chronic conditions as more patients use biologic DMARDs in the future.” – by Jason Laday

Disclosure: Solomon reports receiving grants for his hospital from Amgen, Pfizer, Eli Lilly, AstraZeneca, Genentech, Bristol Myers Squibb, and Corrona. The researchers report grant funding from the Tufts University School of Medicine Harrold Williams Research Fellowship and the NIH.

Andrew Hresko
Daniel Solomon

Medical costs for patients with rheumatoid arthritis treated with biologic disease-modifying antirheumatic drugs are nearly three times higher than costs for patients who use any treatment regimen, according to findings published in Arthritis Care and Research.

“Rheumatoid arthritis is an expensive condition, both in its health effects and the treatments used to manage the illness,” Daniel Solomon, MD, MPH, from the Brigham and Women’s Hospital and Andrew Hresko, BA, from the Tufts University School of Medicine, told Healio Rheumatology. “In the U.S., almost 50% of patients receive expensive targeted therapies, thus it represents an important illness to examine for the cost of care. Additionally, RA is a condition in which there has been significant early adoption of biologic drugs and thus can be a model of how adoption of these drugs in other diseases could affect their cost as well.”

To analyze the direct medical costs related to RA care in the United States since the advent of biologic DMARDs in the late 1990s, the researchers conducted a systematic literature review. After identifying 541 potentially relevant studies, the researchers narrowed their scope to 12 published papers that met their criteria — printed in English with a focus on a U.S. population, analysis of post-1999 data and the inclusion of total direct costs of RA treatment.

Two reviewers independently collected data from the studies, before the researchers analyzed the methods and quality of each. The researchers determined total and RA-related medical costs through random effects meta-analysis, with patients on Medicare and those using biologic disease modifying anti-rheumatic drugs identified as subgroups of interest.

According to the researchers, the estimated total medical cost for all patients with RA is $12,509 (95% CI, $7,451 to $21,001). For all patients treated with biologic disease modifying anti-rheumatic drugs, the total costs were $36,053 (95% CI, $32,138 to $40,445). Among patients using any treatment, RA-related costs accounted for $3,723 (95% CI, $2,408 to $5,762). However, among those treated with biologic disease modifying anti-rheumatic drugs, RA-related costs amounted to $20,262 (95% CI, $17,480 to $23,487).

“We found that the costs for treating rheumatoid arthritis were significantly impacted when biologic DMARDs were chosen,” Solomon and Hresko told Healio Rheumatology. “We have all observed the potential benefits of targeted biologic DMARDs — however, they come with a very large price tag. The clinical significance is to recognize that not only do biologic DMARDs come with a significant price tag to society, but rheumatoid arthritis does as well.”

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The researchers also noted that “the burden of RA patients on the U.S. health care system may become outsized compared to the disease’s relatively small prevalence, and compared to patients with other chronic conditions as more patients use biologic DMARDs in the future.” – by Jason Laday

Disclosure: Solomon reports receiving grants for his hospital from Amgen, Pfizer, Eli Lilly, AstraZeneca, Genentech, Bristol Myers Squibb, and Corrona. The researchers report grant funding from the Tufts University School of Medicine Harrold Williams Research Fellowship and the NIH.