By Wayne Kuznar
Washington, DC—Compliance with treat-to-target guidelines for rheumatoid arthritis (RA) results in fewer inpatient visits, shorter lengths of stay, and lower utilization of emergency department services without additional medical service costs despite more frequent follow-up with a rheumatologist, found Martin J. Bergman, MD, FACR, FACP, Chief, Division of Rheumatology, Taylor Hospital, Ridley Park, PA, and colleagues. They presented their data at the 2012 meeting of the American College of Rheumatology.
Treat-to-target principles include the frequent monitoring of RA disease activity and corresponding drug therapy adjustment at least every 3 months to prevent structural damage and to maximize health-related quality of life through abrogation of inflammation. Although frequent monitoring and fine-tuning of therapy would be expected to increase the costs of the treatment of RA, the full economic implications of a treat-to-target strategy have not been quantified, according to Dr Bergman.
More than 15,000 commercially insured adults with RA who had at least 1 prescription filled for a disease-modifying antirheumatic drug (DMARD) that was preceded by a rheumatologist encounter were identified from a research database and formed the study group. The patients were divided into those who were adherent, which was defined as having had a follow-up visit with a rheumatologist within 90 days after the initiation of a new DMARD, or nonadherent.
Medical resource utilization during the following year was measured. Medical costs from a payer’s perspective were measured over the same time and adjusted to 2010 dollars.
Overall, 71% of the patients were designated as adherent. At baseline, adherent patients had a mean of 4.2 rheumatologist visits compared with a mean of 2.4 visits for nonadherent patients. Outpatient visits were also higher in the adherent versus nonadherent patients (12.8 vs 10.4, respectively). Outpatient costs were $4558 in the adherent group compared with $3630 in the nonadherent group.
Nonbiologic DMARDs were instituted at the index date in 84.4% of the compliant group versus 87.6% of the nonadherent group; biologic DMARDs were initiated in 15.5% and 12.4% of patients, respectively.
“After adjusting for potential confounding, adherent patients exhibited significantly fewer inpatient admissions and inpatient days, fewer emergency department visits, and less use of other medical services but significantly more outpatient visits than nonadherent patients,” according to Dr Bergman.
During follow-up, adherent patients had 14% fewer inpatient visits, 22% fewer inpatient days, 10% fewer emergency department visits, and 7% fewer other visits relative to nonadherent patients. Adherent patients had 5% more outpatient visits versus nonadherent patients.
Inpatient costs were $933 lower in the adherent versus the nonadherent group ($3424 vs $4357, respectively), and outpatient costs were $1665 higher in the adherent group versus the nonadherent group ($13,453 vs $11,788, respectively).
The benefits in terms of inpatient cost reduction overcame the increase of outpatient costs, such that no significant difference in total medical service costs was observed between the 2 cohorts. The total medical service costs were $18,127 in adherent patients and $17,806 in nonadherent patients.