THU0632 Retrospective Analysis of The Association between anti-cyclic Citrullinated Peptide Positivity and Healthcare Costs among Patients with Rheumatoid Arthritis Initiating Conventional Disease-Modifying Antirheumatic Drugs. (15th July 2016)

• Record Type: Journal Article
• Authors: Johnston, S.; Patel, C.; Wilson, K.; Spencer, D.; Rosenblatt, L.
• Is Part Of: Annals of the rheumatic diseases. Volume 75(2016)Supplement 2
• Page Start: 422
• Page End: 422
• Publication Date: 2016-07-15
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2016-eular.1323
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: A recent retrospective analysis of US insurance claims data suggested that, among patients newly diagnosed with RA, those who were anti-cyclic citrullinated peptide (anti-CCP) and/or rheumatoid factor (RF) positive (+) had increased RA-related healthcare costs over a 6-month post-diagnosis period compared with those who were anti-CCP/RF negative (–). 1 Identification and treatment of this poor prognostic factor in the realm of RA diagnosis per the ACR guidelines appear to be of value. Objectives: To investigate the potential role of anti-CCP status in association with clinical outcomes and healthcare costs in conventional (c)DMARD-naïve patients with RA using real-world data. Methods: This was a retrospective, observational cohort study using the MarketScan® US administrative commercial claims and laboratory results databases. Patients included in this study had initiated cDMARD therapy between 1 January 2006 and 1 July 2014 (initiation=index), were aged ≥18 years at index, were continuously enrolled for 12 months before (baseline) and 12 months after (follow-up) index, did not receive cDMARDs or biologics during baseline, had an anti-CCP test result and had ≥2 medical claims with diagnoses of RA during baseline to 3 months after index. Patients were designated anti-CCP+ if their anti-CCP laboratory value was ≥20 IgG Ab units/mL. The study outcomes were all-cause and RA-related (i.e. medical claims with a diagnosis of RA or claims for cDMARDs and biologics) healthcare costs measured over the 12-month follow-up period. Generalized estimating equations were used to estimate the difference in healthcare costs from baseline to follow-up between anti-CCP+ and anti-CCP– patients (i.e. difference-in-difference [DiD]). Results: The study included 635 patients: 391 anti-CCP+ (mean age 52 years; 81% female); 244 anti-CCP– (mean age 52 years, 80% female). Anti-CCP+ and anti-CCP– patients differed substantially with respect to baseline all-cause healthcare costs (mean [SD] anti-CCP+: $7650 [$12, 901], anti-CCP–: $12, 591 [$23, 922]; p<0.001), but not RA-specific costs (mean [SD] anti-CCP+: $809 [$2683], anti-CCP–: $891 [$2629]; p=0.239). In the DiD analysis, which adjusts for baseline differences between groups, anti-CCP+ patients experienced increases in all-cause total healthcare costs that were $2756 greater (p<0.001) than those of anti-CCP– patients; this result was primarily driven by greater increases in outpatient costs ($2274; p<0.001; Table ). Analyses of RA-related healthcare costs were directionally consistent across the categories. Conclusions: After accounting for baseline differences between anti-CCP+ and anti-CCP– patients, anti-CCP+ patients' healthcare costs increased substantially more than anti-CCP– patients over a 12-month follow-up period. Among patients with RA who are newly initiating cDMARDs, anti-CCP positivity may serve as an identifiable predictor for markedly increased future healthcare costs, therefore establishing a need for a more appropriate treatment for cost reduction. References: Johnston S, et al. J Manag Care Pharm 2015;21(Suppl. 10a):S69. Disclosure of Interest: S. Johnston Employee of: Truven Health Analytics; Truven Health Analytics was paid by Bristol-Myers Squibb to conduct this study, C. Patel Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, K. Wilson Employee of: Truven Health Analytics, which was contracted by BMS to conduct this study, D. Spencer Grant/research support from: Bristol-Myers Squibb, L. Rosenblatt Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb