Medication utilization for rheumatoid arthritis among commercially insured patients

Abstract

Background: Tumor necrosis factor inhibitor (TNFi) and non tumor necrosis factor (TNF) biologics are specialty drugs recommended by the American College of Rheumatology (ACR) guideline for the treatment of rheumatoid arthritis (RA). Barriers to their use include cost, side effects, and route of administration. Objective: The primary objective of this study was to evaluate how RA medication utilization among a commercially insured population compares to treatment recommendations from the ACR guideline for the treatment of RA. Methods: This retrospective cross-sectional study used data from commercially insured patients from the Optum Data Warehouse. Patients were included if they had continuous medical and pharmacy coverage from January through December 2017 and at least one medical claim with a diagnosis code for RA. Pharmacy claims were included if the medication on the claim could be used for the treatment of RA. The proportion of the population using selected ACR regimens was calculated. Total cost of RA-related care was compared among users and non-users of specialty drugs. Results: A total of 7219 patients were included in the study. The proportion of specialty drug users and non-users was 32.0% and 60.1%, respectively, while 7.5% of patients did not have any RA-related drug claims. ACR recommended regimens targeted at early RA or established RA patients with low disease activity were used by 26.2% of patients. For early or established RA with moderate or high disease activity, methotrexate and TNFi combination therapy was the most common (10.8%) ACR regimen used while a disease modifying antirheumatic drug (other than methotrexate) and TNFi combination therapy was used by 7.5% of patients. Total cost of RA care was $37,530 ($23,647 to $49,541) for specialty drug users and $982 ($326 to $2114) for non-users of specialty drugs ($36,548; 95% CI: $34,158 to $35,911). Conclusions: Medication utilization adhered to ACR recommendations in this commercially insured population.