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Background: Limited information is available on the impact of target disease-modifying anti-rheumatic drugs (tDMARD) on patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM).
Objectives: The objective was to compare T2DM-related healthcare resource utilization (HCRU) and cost for TNF inhibitors (TNFi)-naive patients pooled from two commercial databases with RA and T2DM receiving abatacept, other non-TNFi, or TNFi.
Methods: A retrospective, observational study was conducted with MarketScan and PharMetrics (January 2008-September 2018). The study population included TNFi-naïve adult patients with RA and T2DM newly initiating abatacept, TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or other non-TNFi (tocilizumab, anakinra, sarilumab, rituximab, tofacitinib). Date of tDMARD initiation was the index date. Patients had ≥2 RA diagnoses separated by ≥7 days, ≥1 T2DM diagnosis, and had ≥12 months of pre-index continuous enrollment. Follow-up ended at the end of patient insurance enrollment, study period or index treatment. T2DM-related HCRU and costs including inpatient stay, outpatient visits, ER visits, and pharmacy use were measured on a per-patient-per-month (PPPM) basis (2018 USD). Patients treated with abatacept were matched to TNFi and non-TNFi cohorts separately by propensity score adjusted with patients baseline comorbidities, HCRU, and costs.
Results: A total of 16,236 patients meeting criteria were identified. Most patients were female (74.3%), and the overall average age of 55.4 years (
Patient Characteristics
|
Abatacept
|
Non-TNFi
|
TNFi
|
Total
|
|
|---|---|---|---|---|
| Age, mean years (SD ) | 58.5 (11.3) | 57.7 (11.2) | 54.9 (10.6) | 55.41 (10.7) |
| Gender, female, n (% ) | 936 (82.5) | 993 (73.4) | 10,142 (73.8) | 12,071 (74.3) |
| CCI, mean (SD ) | 2.2 (1.4) | 2.3 (1.4) | 1.8 (1.1) | 1.89 (1.14) |
| DCSI, n (% ) | ||||
| Cardiovascular | 361 (31.8) | 406 (30.0) | 2,500 (18.2) | 3,267 (20.1) |
| Neuropathy | 294 (25.9) | 374 (27.6) | 3,161 (23.0) | 3,829 (23.6) |
| Nephropathy | 146 (12.9) | 193 (14.3) | 1,151 (8.4) | 1,490 (9.2) |
| PVD | 131 (11.6) | 155 (11.5) | 874 (6.4) | 1,160 (7.1) |
| Retinopathy | 103 (9.1) | 119 (8.8) | 922 (6.7) | 1,144 (7.0) |
| Cerebrovascular | 74 (6.5) | 102 (7.5) | 620 (4.5) | 796 (4.9) |
| Metabolic | 9 (0.8) | 20 (1.5) | 141 (1.0) | 170 (1.0) |
CCI: Charlson comorbidity index; DCSI: diabetes complications severity index; PVD: peripheral vascular disease.
Adjusted T2DM-related HCRU and Costs after Propensity Score Matching
|
Abatacept
|
Non-TNFi
| Diff (ABA- Non-TNF ) |
Abatacept
|
TNFi
| Diff (ABA- TNF ) | |
|---|---|---|---|---|---|---|
| T2DM-related HCRU (per 1000 Patients per Month ) | ||||||
| Number of Hospitalizations | 13.9 | 20.4 | -6.5* | 12.6 | 14.9 | -2.3* |
| Number of
| 22.0 | 16.1 | 5.9* | 18.4 | 16.3 | 2.0* |
| Number of
| 311 | 334.8 | -23.7* | 299.3 | 286.9 | 12.4 |
| T2DM-related Costs (PPPM $ ) | ||||||
| Inpatient Costs | 507 | 535 | -28 | 413 | 475 | -62 |
| ER Costs | 27 | 17 | 10* | 22 | 25 | -3 |
| Outpatient Costs | 190 | 323 | -133 | 186 | 170 | 16* |
| Pharmacy Costs | 107 | 100 | 7* | 97 | 128 | -31 |
| Total Costs | 831 | 975 | -144 | 719 | 798 | -79* |
*P<0.05
Conclusion: TNFi-naive RA patients with T2DM newly initiating abatacept had lower adjusted rates of T2DM-related hospitalizations compared to patients who initiated a non-TNFi or a TNFi. Total costs were lower among patients initiating abatacept vs. patients who initiated a non-TNFi or a TNFi. Findings suggest that initial abatacept among TNFi-naïve patients may be able to reduce healthcare utilization arising from T2DM complications and reduce T2DM-related costs in RA patients.
Disclosure of Interests: Xue Han Employee of: BMS, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Ying Bao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Vardhaman PATEL Employee of: Bristol Myers Squibb, Amrina Roy Employee of: Mu-Sigma, Varshini Rajagopalan Employee of: Mu-Sigma, Francis Lobo Shareholder of: Bristol-Myers Squibb (US), Employee of: Bristol-Myers Squibb (US)