Study: Etanercept Reduces Healthcare Utilization for Patients With Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) have high healthcare utilization and high healthcare costs, which place a burden on health systems and patients alike. However, a recently published retrospective cohort study found that effective treatment for RA (namely, treatment with etanercept) may lead to lower overall and lower RA-related healthcare utilization.

The study, by Neil A. Accortt and colleagues, published in Advances in Therapy, drew data from the Truven Health Analytics MarketScan Database, which includes health insurance claims from employers and health plans across the United States. Data from 6737 patients were analyzed to compare differences in healthcare utilization pre- and post-initiation of the anti—tumor necrosis factor agent etanercept for the period from 2009 to 2014. Study outcomes were evaluated for the 12-month period before and the 12-month period after treatment initiation with the reference etanercept, Enbrel. (While a biosimilar of etanercept has been approved by the FDA, it has not yet launched in the United States.)

The assessment of healthcare utilization included office visits, inpatient admissions, emergency department visits, outpatient services, RA-related procedures, pharmacotherapy, tests, and some comorbidities (RA-related utilization was determined by a diagnosis of RA as the primary diagnosis on claims forms).

The researchers found that use of non-biologic disease-modifying anti-rheumatic drugs (nbDMARD), oral corticosteroids, oral opioid analgesics, and oral non-steroidal anti-inflammatory drugs (NSAID) were significantly lower after etanercept was initiated. The percentage of patients using drugs in each category pre- and post-initiation of etanercept was as follows:

• nbDMARDs: 87.1%, 79.1%
• Oral corticosteroids: 70.6%, 56.7%
• Oral opioids: 54.8%, 52.2%
• Oral NSAIDS, 50.8%, 39.4%

“This observation is notable,” the authors state, “as decreased exposure also reduces the risk of adverse events associated with these medications.”

Overall healthcare utilization also dropped for patients after they initiated etanercept treatment: patients had approximately 1 fewer outpatient service (mean, 22 visits pre-initiation versus 21.4 visits post-initiation), and 1 fewer office visit (mean, 17.1 visits pre-initiation versus 16.2 visits post-initiation). The most compliant patients had, on average, 3 fewer office visits than the least compliant.

The authors concluded that overall healthcare utilization decreased after patients initiated etanercept, and that greater compliance was linked to significantly lower utilization.

The authors note that their study was limited by the fact that claims data have the risk of misclassification or coding errors, as well as by the fact that no data on disease activity or severity were available for the patients in the cohort. However, the study did include a large sample size of patients, and the pre- and post-initiation design of the study allowed patients to act as their own controls.