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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pharmacol. | doi: 10.3389/fphar.2019.01214

Comparison of Healthcare Utilization and Costs between RA Patients receiving Biological and Conventional Synthetic DMARDs: A Nationwide Population-based Cohort Study in Taiwan

Der-Yuan Chen1, 2, 3,  Fun Yu4,  Li-Wen Duan5 and Chao-Hsiun Tang6*
  • 1Rheumatology and Immunology Center, China Medical University Hospital, Taiwan
  • 2College of Medicine, China Medical University, Taiwan
  • 3Center of Rheumatology and Immunology, China Medical University Hospital, Taiwan
  • 4Pfizer (Taiwan), Taiwan
  • 5Other, Taiwan
  • 6School of Health Care Administration, Taipei Medical University, Taiwan

Background. The therapy with biological disease-modifying anti-rheumatic drugs (bDMARDs) has proven to rapidly reduce articular symptoms/signs, decrease morbidities and improve health outcome in patients with rheumatoid arthritis (RA) and be cost-effectiveness in Western countries. However, the difference in healthcare utilization and costs between conventional synthetic DMARDs (csDMARDs) and bDMARDs in the treatment of RA patients in Taiwan remains largely unexplored.
Methods. Two cohorts of RA patients and their matched controls were identified from the National Health Insurance Research database (NHIRD). The csDMARD cohort comprised of patients who submitted claims during 1997-2003 for cyclosporine≥50 mg/day with concomitant use of ≥2 csDMARDs for ≥28 days (n=1,569), whilst the bDMARD cohort comprised of patients who had ≥1 claim during 2003-2011 for bDMARD (n=1,530). The per-patient per-year healthcare utilization and costs were estimated by bootstrapping method, with a comparison being undertaken between csDMARD and bDMARD.
Results. The incremental number of hospitalization days was reduced from 2.3 days for csDMARD to 0.58 day for bDMARD). When compared to csDMARD-treated patients, the incremental total costs and RA-related medication costs were significantly higher in bDMARD-treated patients (US$9,081 vs. US$2,481; US$8,992 vs. US$1,883). However, the combined incremental healthcare utilization costs and non-RA medication costs were significantly lower in bDMARDs-treated patients compared to csDMARD-treated patients (US$374.7 vs. US$1156.2).
Conclusion. Although total costs increased as a result of introducing biologics in RA treatment, biologics have undoubtedly given rise to the benefits of reduced healthcare utilization. The increase in medication costs from biologics was offset by the lower costs of healthcare utilization. Our findings suggest that the medication costs of biologics may be alleviated by an improvement in clinical outcomes.

Keywords: Rheumatoid arthritis, biologics, healthcare utilization and cost, Taiwan, DMARD (Disease Modifying Anti-Rhuematic Drugs)

Received: 11 Jul 2019; Accepted: 23 Sep 2019.

Copyright: © 2019 Chen, Yu, Duan and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Chao-Hsiun Tang, Taipei Medical University, School of Health Care Administration, Taipei, 11049, Taipei County, Taiwan, chtang@tmu.edu.tw