Talk: Comorbidity and Cost Burden of Patients Prior to Initiating Abatacept or Infliximab As First Line Biologic Therapy for the Treatment of Rheumatoid Arthritis (2011 ACR/ARHP Annual Scientific Meeting)

Monday, November 7, 2011: 9:00 AM-6:00 PM

Hall F2 - Poster Hall (McCormick Place West)

Theodore Darkow, Digisha Trivedi, Brian Meissner, Lisa Rosenblatt and Tony Hebden, Bristol-Myers Squibb, Plainsboro, NJ

Presentation Number: 1242

Background/Purpose: Patients with rheumatoid arthritis (RA) typically have significant comorbidity which, along with underlying RA severity, may impact both choice and response to treatment. Prior research has shown that, compared with patients initiating subcutaneous biologic therapy, patients who receive an intravenous (IV) biologic have higher baseline RA-related costs, suggesting more severe disease. However, a description of the characteristics of patients initiating IV biologic therapy has not been done.

Objectives: Characterize baseline healthcare costs and degree of comorbidity and disease severity in RA patients, prior to initiating first-line treatment with the IV administered biologic agents abatacept or infliximab.

Method: Utilizing a large, managed care plan claims database, an analysis was conducted in adult RA patients during the 6 months prior to initiating first-line biologic treatment with abatacept or infliximab. The identification period was January 1, 2006 through August 31, 2010. Severity of overall comorbidity was described using Charlson Comorbidity Index (CCI) and all-cause health care costs, while RA-related healthcare costs were used as a proxy measure for severity of RA.

Result: A total of 1623 RA patients were identified who initiated abatacept or infliximab as first-line biologic therapy. Baseline RA-related healthcare costs for abatacept treated patients (n=411) were approximately twice those of patients treated with infliximab (n=1212). Baseline total all-cause health care costs and CCI were also significantly higher for abatacept treated patients (Table).

Abatacept

Infliximab

p-value

Mean (SD)

Mean (SD)

Baseline Charlson Comorbidity Index

1.64 (1.17)

1.44 (0.92)

0.001

Baseline RA-related health care costs

$3,145 ($10,774)

$1,506 ($4,406)

0.003

Baseline all-cause health care costs

$7,491 ($16,886)

$4,548 ($8,529)

<0.001

Conclusion: In a commercially insured population, those patients initiating first-line abatacept appeared to demonstrate greater baseline severity of RA, as well as more comorbidity than those who received first-line infliximab. Further research is required to better understand how pre-existing conditions and severity of RA impact selection of intravenous biologic therapy and subsequent response in this patient population.

Keywords: abatacept, clinical trials, comorbidity, infliximab and rheumatoid arthritis (RA)

Disclosure: T. Darkow, Bristol-Myers Squibb, 1, Bristol-Myers Squibb, 3 ; D. Trivedi, Bristol-Myers Squibb, 1, Bristol-Myers Squibb, 3 ; B. Meissner, Bristol-Myers Squibb, 1, Bristol-Myers Squibb, 3 ; L. Rosenblatt, Bristol-Myers Squibb, 1, Bristol-Myers Squibb, 3 ; T. Hebden, Bristol-Myers Squibb, 1, Bristol-Myers Squibb, 3 .

1242 - Comorbidity and Cost Burden of Patients Prior to Initiating Abatacept or Infliximab As First Line Biologic Therapy for the Treatment of Rheumatoid Arthritis