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

objectiveThe study assessed persistence rates of biological disease-modifying antirheumatic drugs (bDMARDs) for the treatment of rheumatoid arthritis in Japan and compared resource utilization and treatment costs between persistence and non-persistence groups.

methodsData were extracted from a Japanese claims database between 2009 and 2015. bDMARD-naïve patients were identified and included in the final analysis. Survival analysis was used to estimate 1-year persistence rates for current bDMARDs. Propensity score matching was applied to control for potential treatment selection bias. Resource utilization and healthcare costs were calculated 1 year before and after initiation of bDMARDs and compared between persistence and non-persistence groups.

resultsA total of 6153 bDMARD-naïve patients were identified and the overall 1-year persistence rate was 85% (95% CI 84-86). Overall, 1-year outpatient visits increased from 10 at baseline to 16 after bDMARD treatment, while the number of hospital admissions declined from 3.3 to 1.6. The non-persistence group had a larger increase in outpatient visits after bDMARD initiation compared with the persistence group (8-16 vs. 10-16, respectively) and a smaller decrease in hospital admissions (3.1-1.9 vs. 3.5-1.4, respectively). Persistence was associated with a reduction in total healthcare costs of US$760.

conclusionsJapanese bDMARD-naïve patients with RA have a high persistence rate with those treatments. The reduction in medication costs in non-persistent patients is offset by higher hospitalization costs, making non-persistence more expensive.