The Economic Benefit of Remission for Patients with Rheumatoid Arthritis

Area of Science:

• Rheumatology
• Health Economics
• Real-World Evidence

Background:

• Rheumatoid arthritis (RA) treatment guidelines emphasize remission or low disease activity (LDA).
• Limited real-world data exists on the association between RA disease activity (DA) control and healthcare costs.
• This study addresses the evidence gap by examining RA costs across different DA states and therapies.

Purpose of the Study:

• To evaluate the association between rheumatoid arthritis disease activity states and associated healthcare costs.
• To compare the cost of care based on different rheumatoid arthritis treatment strategies, including conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologics, and targeted synthetic (ts)DMARDs.
• To analyze within-person changes in healthcare costs before and after initiating new RA therapies.

Main Methods:

• Retrospective cohort study linking medical/prescription claims with electronic health record data (1/1/2010-3/31/2020).
• Analysis of mean annual costs stratified by DA state (remission, LDA, moderate DA, high DA) and baseline therapy.
• Multivariate negative binomial regression adjusted for baseline characteristics.

Main Results:

• Mean annual costs were lowest for patients in remission ($40,072) compared to moderate ($56,536) and high DA ($59,217).
• In remission, csDMARDs had the lowest mean annual cost ($25,575), while tsDMARDs were highest ($75,512).
• Initiating biologics (TNFi and non-TNFi) led to LDA/remission in 31% and 26% of patients, respectively, with lower medical/inpatient costs post-LDA/remission.

Conclusions:

• Healthcare costs increase with higher rheumatoid arthritis disease activity.
• Achieving remission or LDA in RA patients is associated with significantly lower overall healthcare expenditures.
• While optimizing RA disease control offers potential cost savings, the high cost of targeted therapies needs consideration.