TY - JOUR
T1 - Diabetes-Related Complications and Costs in Medicare Beneficiaries with Comorbid Rheumatoid Arthritis and Diabetes Treated with Abatacept Versus Other Targeted DMARDs
AU - Patel, Vardhaman
AU - Pulungan, Zulkarnain
AU - Shah, Anne
AU - Jones, Barton
AU - Petrilla, Allison
AU - Ferri, Leticia
AU - Han, Xue
AU - Michaud, Kaleb
N1 - Funding Information:
Sponsorship for this study and Rapid Service Fee were funded by Bristol Myers Squibb.
Funding Information:
Sponsorship for this study and Rapid Service Fee were funded by Bristol Myers Squibb. All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. The analysis was conducted independently by Zulkarnain Pulungan, Anne Shah, Barton Jones, and Allison Petrilla of Avalere Health. Bristol Myers Squibb and Avalere Health collaborated on study design and interpretation of results. All authors contributed towards the study design, analysis, interpretation of results, drafting and reviewing of the manuscript, and approval of publication. Anny Wong, affiliated with Avalere Health at the time of analysis, provided research support, data interpretation, and manuscript writing for the study. Editorial assistance was provided by Rachel Rankin, PhD, at Caudex and was funded by Bristol Myers Squibb. A portion of these results were previously presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting, November 8–13, 2019; Atlanta, GA, USA: Patel V, Pulungan Z, Shah A, et al. Arthritis Rheumatol 2019;71(suppl 10):abstract 1049; and Patel V, Pulungan Z, Shah A, et al. Arthritis Rheumatol 2019;71(suppl 10):abstract 2366. The study and poster development were sponsored by Bristol Myers Squibb. Vardhaman Patel, Leticia Ferri, and Xue Han are employees of and shareholders in Bristol Myers Squibb. Kaleb Michaud received grant funding from Rheumatology Research Foundation at the time the study was conducted. Zulkarnain Pulungan, Barton Jones, and Allison Petrilla are employees of Inovalon Insights and were affiliated with Avalere Health at the time the study was conducted. Anne Shah is a former employee of Avalere Health, currently affiliated with AstraZeneca. This retrospective study was carried out in accordance with the Declaration of Helsinki. The study was limited to data without identifiers to ensure confidentiality, and no personal health information was collected. Because of the retrospective study design using previously collected de-identified data, formal consent and institutional review board approval was not necessary for this study. The data described in this paper are sourced from CMS Medicare Fee-for-Service claims and enrollment data. The datasets generated during and/or analyzed during the current study are not publicly available due to protection of patient privacy. Researchers may request use of CMS data through ResDAC.
Funding Information:
Vardhaman Patel, Leticia Ferri, and Xue Han are employees of and shareholders in Bristol Myers Squibb. Kaleb Michaud received grant funding from Rheumatology Research Foundation at the time the study was conducted. Zulkarnain Pulungan, Barton Jones, and Allison Petrilla are employees of Inovalon Insights and were affiliated with Avalere Health at the time the study was conducted. Anne Shah is a former employee of Avalere Health, currently affiliated with AstraZeneca.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/8
Y1 - 2022/8
N2 - Introduction: Targeted DMARD (tDMARD) use in patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) may increase whole-body insulin sensitivity. Evidence comparing the T2DM-related clinical and economic impact of abatacept versus other tDMARDs is limited. This study compared differences in T2DM-related healthcare resource utilization (HCRU) and costs in patients with RA and T2DM. Methods: This retrospective study used 100% Medicare Fee-for-Service claims (parts A/B/D) to identify patients ≥ 65 age, diagnosed with RA and T2DM, and were either TNFi-experienced (switched from a TNFi to another tDMARD) or tDMARD-naïve, initiating their first tDMARD (abatacept, TNFi, or non-TNFi) between 2010 and 2017. Abatacept users were propensity-score (PS) matched to TNFi and other non-TNFi users separately on baseline demographics, comorbidities, medications, T2DM-related HCRU, and costs. Post-index follow-up: until discontinuation of index treatment, disenrollment, death, or end of study period, whichever occurred first. T2DM-related complications and HCRU were assessed. Costs were normalized to per-patient-per-month (PPPM) and inflated to 2019 US$. Results: The TNFi-experienced group included 2169 abatacept/TNFi and 2118 abatacept/other non-TNFi PS-matched pairs; the tDMARD-naïve group included 2667 abatacept/TNFi and 2247 abatacept/other non-TNFi PS-matched pairs. For TNFi-experienced patients, T2DM-related complication rates for inpatient settings PPPM trended lower for abatacept than TNFi (21 vs. 24, p = 0.046) and other non-TNFi groups (21 vs. 26; p < 0.0001). T2DM-related total costs PPPM for TNFi-experienced patients demonstrated lower trends for abatacept than TNFi ($489 vs. $594, p = 0.016) and other non-TNFi users ($493 vs. $606, p = 0.012). Conclusions: Medicare beneficiaries with RA and T2DM who switch to/initiate abatacept as their first tDMARD have directionally lower rates and costs of T2DM-related complications compared with patients switching to/initiating other tDMARDs. Abatacept treatment may help reduce clinical and economic burdens associated with T2DM in patients with RA.
AB - Introduction: Targeted DMARD (tDMARD) use in patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM) may increase whole-body insulin sensitivity. Evidence comparing the T2DM-related clinical and economic impact of abatacept versus other tDMARDs is limited. This study compared differences in T2DM-related healthcare resource utilization (HCRU) and costs in patients with RA and T2DM. Methods: This retrospective study used 100% Medicare Fee-for-Service claims (parts A/B/D) to identify patients ≥ 65 age, diagnosed with RA and T2DM, and were either TNFi-experienced (switched from a TNFi to another tDMARD) or tDMARD-naïve, initiating their first tDMARD (abatacept, TNFi, or non-TNFi) between 2010 and 2017. Abatacept users were propensity-score (PS) matched to TNFi and other non-TNFi users separately on baseline demographics, comorbidities, medications, T2DM-related HCRU, and costs. Post-index follow-up: until discontinuation of index treatment, disenrollment, death, or end of study period, whichever occurred first. T2DM-related complications and HCRU were assessed. Costs were normalized to per-patient-per-month (PPPM) and inflated to 2019 US$. Results: The TNFi-experienced group included 2169 abatacept/TNFi and 2118 abatacept/other non-TNFi PS-matched pairs; the tDMARD-naïve group included 2667 abatacept/TNFi and 2247 abatacept/other non-TNFi PS-matched pairs. For TNFi-experienced patients, T2DM-related complication rates for inpatient settings PPPM trended lower for abatacept than TNFi (21 vs. 24, p = 0.046) and other non-TNFi groups (21 vs. 26; p < 0.0001). T2DM-related total costs PPPM for TNFi-experienced patients demonstrated lower trends for abatacept than TNFi ($489 vs. $594, p = 0.016) and other non-TNFi users ($493 vs. $606, p = 0.012). Conclusions: Medicare beneficiaries with RA and T2DM who switch to/initiate abatacept as their first tDMARD have directionally lower rates and costs of T2DM-related complications compared with patients switching to/initiating other tDMARDs. Abatacept treatment may help reduce clinical and economic burdens associated with T2DM in patients with RA.
KW - Abatacept
KW - DMARD
KW - Healthcare resource utilization
KW - Rheumatoid arthritis
KW - Type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85130684086&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130684086&partnerID=8YFLogxK
U2 - 10.1007/s40744-022-00453-w
DO - 10.1007/s40744-022-00453-w
M3 - Article
C2 - 35604547
AN - SCOPUS:85130684086
SN - 2198-6576
VL - 9
SP - 1091
EP - 1107
JO - Rheumatology and Therapy
JF - Rheumatology and Therapy
IS - 4
ER -