Effectiveness and Costs of TNF-Alpha Blocker Use for Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is ranked among the highest of all chronic diseases in terms of its adverse impact on health-related quality of life, limitations in physical function, increased pain and fatigue, and diminished work performance and attendance compared with other debilitating chronic conditions.

To compare healthcare expenditures, utilization, and productivity-related outcomes for patients with RA using tumor necrosis factor (TNF)-alpha blockers compared with patients with mild, moderate, or severe RA who are not using these medications.

Patients with RA were identified from the 1998-2007 Medical Expenditure Panel Survey database, using International Classification of Diseases, Ninth Revision, Clinical Modification codes (714.xx); the patients were classified as (1) TNF-alpha blocker users, identified on the basis of pharmacy or intravenous therapy utilization, or (2) TNF-alpha blocker nonusers (but could be using other RA-related medications). Patients who were not using TNF-alpha blockers were subclassified as having mild, moderate, or severe RA; nonusers were not subclassified by disease severity. An algorithm was created for this study that combined and ranked 5 patient-reported health-related outcomes used to classify RA severity in the TNF-alpha blocker nonusers group. The main outcome measures included healthcare expenditures, medical service utilization, and work-related productivity for patients with RA.

A total of 1152 patients were included in this study. TNF-alpha blocker users (N = 65) were found to have lower odds of being unemployed compared with nonusers who had moderate (N = 159) or severe (N = 208) RA, using patients with mild RA as the reference group (N = 720; P <.01 for both comparisons). Only significant results were included in this study. There were no differences between patients with mild RA who were TNF-alpha blocker users versus nonusers with regard to all-cause emergency department visits, hospitalizations, and average length of hospital stay. The medical, prescription, and total healthcare costs were higher for TNF-alpha blocker users than for patients with mild RA who did not use these agents. Patients with moderate or severe RA who did not use TNF-alpha blockers also had higher incremental annual medical expenditures ($1088 and $1640, respectively) than nonusers with mild RA; these incremental cost differences were lower than the difference in users of TNF-alpha blockers ($2096).

Based on this study, the use of TNF-alpha blocker treatment had a positive impact on employment status and was associated with fewer hospitalizations compared with other RA medications and compared with patients who did not use TNF-alpha blockers in patients with moderate or severe RA. The determination of RA severity may be biased, because it was based on patient self-reports and not on provider assessments; however, self-reporting is a common, validated method of assessing RA severity.