Healthcare resource utilization and costs among patients with rheumatoid arthritis on biologic therapies in Taiwan: A 1-year mirror-image study using a national claims database

• Published in: PloS one 2018-07, Vol.13 (7), p.e0200758-e0200758
• Main Authors: Chen, Kuan-Chen, Wu, Chu-Hua, Tang, Chao-Hsiun, Huang, Kuo-Cherh
• Format: Article
• Language: English
• Subjects: Adalimumab - therapeutic use; Adult; Aged; Ambulatory care; Analysis; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - economics; Biology and Life Sciences; Cost analysis; Cost of Illness; Costs; Databases, Factual; Diagnosis; Drug Costs; Emergency medical care; Emergency medical services; Etanercept - therapeutic use; Female; Health care; Health Care Costs; Health care expenditures; Health care policy; Health insurance; Humans; Information processing; Insurance Claim Review; Male; Medical care utilization; Medical research; Medicine and Health Sciences; Middle Aged; Mortality; Patients; People and Places; Population; Population studies; Quality of life; Resource utilization; Retrospective Studies; Rheumatoid arthritis; Risk factors; Social Sciences; Studies; Taiwan; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Tumor necrosis factor-α
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0200758

This nationwide population-based study aimed at evaluating healthcare resource utilization and direct medical costs among rheumatoid arthritis (RA) patients receiving biologic therapies in Taiwan. A retrospective cohort of 2,425 RA patients who had received first-line tumor necrosis factor (TNF)-α antagonist treatment for at least 6 months (the baseline period) between 2007 and 2011 was identified from the National Health Insurance Research Database in Taiwan. Healthcare resource utilization and direct medical costs of those patients were analyzed and compared 1 year before the index date and during the 1-year follow-up. Analytical results demonstrated that 87.7% of RA patients received the same TNF-α antagonist during the 1-year follow-up, 2.4% of the patients switched to another TNF-α antagonist after the baseline period, 7.1% of the study cohort received a second-line biologic agent, while the remaining patients discontinued use of any TNF-α antagonist. Compared to 1 year before the index date, there were significant reductions in emergency room visits and hospitalization days for RA patients treated with the same TNF-α antagonist during the 1-year follow-up. However, there was an increase of outpatient visits among those patients. For those RA patients who switched to another TNF-α antagonist or received a second-line biologic agent, they consumed more healthcare resources. Furthermore, the corresponding medication costs went up markedly during the 1-year follow-up, but nearly all total direct medical costs (biologics excluded) were significantly reduced across the study cohort. Lastly, male patients incurred slightly higher medical costs than their counterparts, albeit in a statistically insignificant fashion. This investigation revealed that RA patients treated with biologics utilized fewer emergency room visits and shorter hospitalization days, but incurred higher costs. In summary, this study provides meaningful information on healthcare resource utilization and medical costs of RA patients for healthcare providers and policymakers.