Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence

Abstract

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3 years showed that GLM had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

Persistence with Biological Disease-modifying Antirheumatic Drugs and Its Associated Resource Utilization and Costs

“…1a). This definition of persistence was consistent with that employed in other claims data-based studies of RA [10, 26] and other indications [27, 28].

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“…The Swedish study reported that persistence was associated with a cost savings of US$987, while non-persistence led to a cost increase of US$793 [10]. Of note, the cost of the bDMARDs was not included in this analysis.…”

“…With one notable exception from Sweden, few studies have calculated the cost implications of low persistence rates [10]. In the Swedish study, the authors compared the cost for patients who reliably took their medication over a 1-year period with that of patients who discontinued their treatment.…”

Persistence with golimumab in immune-mediated rheumatic diseases: a systematic review of real-world evidence in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis

“…Subsequently, five studies were excluded on the basis that they presented persistence estimates from the same, or partially the same, patients from the same data source as other studies 28–32. Therefore, a total of twelve references were included in the review 20,33–43Figure 1 provides a description of the flow of information during the selection process.…”

“…Figure 1 provides a description of the flow of information during the selection process. Among the twelve references, all presented proportions of patients on golimumab at reported follow-up(s), and one reported median time to 50% of patients being nonpersistent 33. Five studies compared persistence to golimumab with persistence to other TNFis 20,33,34,36,38…”