Economic Evaluation of Anticyclic Citrullinated Peptide Positivity in Rheumatoid Arthritis

Abstract

BACKGROUND: Anticyclic citrullinated peptide (anti-CCP) positivity may be a strong predictor of joint erosion and a potential biomarker for guiding treatment decisions for rheumatoid arthritis (RA). However, limited studies are currently available on the effect of anti-CCP positivity on health care utilization and/or medical costs of RA patients. OBJECTIVE: To investigate short-term and long-term direct health care expenditures associated with anti-CCP positivity in newly diagnosed RA patients.METHODS: A retrospective cohort study was conducted in adult RA patients within a U.S. integrated health care delivery system (January 1, 2007-June 30, 2015. Patients were required to have 2 RA diagnoses and treatment with a conventional or biologic disease-modifying antirheumatic drug (DMARD) within 12 months. The first RA diagnosis date was labeled as the index date, and patients were followed until they left the health plan, died, or reached the end of the study period. Patient demographics, anti-CCP results, comorbid conditions, and health care resource utilization during baseline (12 months before the index date) and follow-up periods were collected. Nationally recognized direct medical costs were assigned to health care utilization to calculate health care costs in 2015 U.S. dollars. The baseline differences between anti-CCP positivity and negativity and differences in censoring during follow-up were addressed using propensity scores. The mean differences in costs were estimated using recycled prediction methods.RESULTS: 2,448 newly diagnosed RA patients were identified and followed for a median of 3.7 years (range = 1-8 years). At baseline, 65.8% of patients were anti-CCP positive. Anti-CCP-positive patients had fewer comorbid conditions at baseline. During the first 12 months of follow-up, median (interquartile range) total health care expenditures for anti-CCP-positive

Comparison of healthcare resource utilization and medical costs between patients with seropositive and seronegative rheumatoid arthritis

“…Previous US studies have also shown that the difference in medication utilization and its cost was a major factor underlying the difference in medical expenses between SPRA and SNRA. 16,17 In our study, RA-related OPD visits by SPRA patients were more frequent than in SNRA. Intensive managements of RA may lead to higher drug and laboratory test costs for monitoring of safety and effectiveness of medication, including bDMARDs.…”

Persistence with Early-Line Abatacept versus Tumor Necrosis Factor-Inhibitors for Rheumatoid Arthritis Complicated by Poor Prognostic Factors

“…6 ACPA seropositivity has been found to predict development of aggressive RA, resulting in higher economic burden, health-care resource utilization, and prescription costs. [8][9][10] Treatment of RA usually begins with conventional, or "traditional," disease-modifying antirheumatic drugs (DMARDs), including methotrexate, sulfasalazine, and others. Patients with an inadequate response to nonbiologic DMARDs often progress to biologic DMARDs, including tumor necrosis factor-inhibitors (TNFis), IL-6 receptor antagonists (i.e., tocilizumab and sarilumab), the anti-CD20 monoclonal antibody rituximab, and T-cell co-stimulators such as abatacept.…”