Healthcare utilization and costs in patients with rheumatoid arthritis using biologics or tofacitinib: a nationwide, population-based study.

backgroundRheumatoid arthritis (RA) is a chronic inflammatory systemic disease, and the use of biological agents in the treatment of RA in recent years has significantly improved RA disease activities and clinical outcomes. However, the greatly increased medical costs due to the high costs of biologics are a major concern. We aimed to investigate healthcare utilization and costs in patients with RA pre- to post-initiation of biologics or tofacitinib.

methodsWe conducted a nationwide, population-based study from 1996 to 2017 using Taiwan's National Health Insurance Research Database (NHIRD). In total, 57,084 newly diagnosed RA patients aged ≥ 20 years were identified, of whom 10,566 patients using biologics or tofacitinib were selected and included in the final analysis. The dose adjustments of anti-rheumatic drugs and healthcare utilization and costs among RA patients 3 months before and 6 months after use of biologics were compared. Additionally, a sensitivity analysis evaluating healthcare utilization and costs over a 12-month period pre- to post-initiation of biologics or tofacitinib was conducted.

resultsRA patients had more frequent all-cause and RA-related outpatient department (OPD) visits after receiving biologics or tofacitinib, but fewer RA-related emergency room (ER) visits (0.00 ± 0.04 times/month, p = 0.005). There were fewer OPD visits and lower OPD healthcare costs in RA patients using tocilizumab (OPD visits: β - 0.20, p = 0.013; OPD costs: β - 16,366.92, p < 0.001) and abatacept (OPD visits: β - 0.41, p < 0.001; OPD costs: β - 4436.24, p < 0.001), compared with etanercept users. Moreover, significant dose reductions of concomitant anti-rheumatic drugs were observed in RA patients after biologics or tofacitinib, including corticosteroid, leflunomide, hydroxychloroquine, and cyclosporin. Between 10.8 and 47.0% of RA patients experienced a reduction in the dose of anti-rheumatic drugs.

conclusionsThis nationwide, population-based study revealed that the dose of concomitant anti-rheumatic drugs and RA-related ER visits significantly reduced after initiating biologics or tofacitinib. Compared with etanercept users, patients treated with tocilizumab or abatacept had significantly lower outpatient care-related visit numbers and costs. Key Points • This nationwide population-based study investigated healthcare utilization and costs in RA patients pre- to post-initiation of biologics or tofacitinib. • RA-related emergency room visits and doses of concomitant anti-rheumatic drugs significantly declined after starting biologic or tofacitinib therapy, suggesting improved disease control. • Tocilizumab and abatacept use were associated with fewer outpatient visits and lower costs than etanercept, offering more resource-efficient options for certain patients. • Older age, male sex, and higher comorbidity burden predicted more dose reduction of conventional anti-rheumatic medications, supporting individualized treatment planning and de escalation strategies in clinical practice.