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AbstractObjective:To estimate comprehensive cost of rheumatoid arthritis (RA) patients to society and individual stakeholders, including patients/employees, employers, family members/caregivers, and government.Research design and methods:Administrative claims databases covering privately insured and Medicare and Medicaid beneficiaries in the US were used to compute the excess payer and beneficiary-paid costs per patient with RA compared with matched controls. Similarly, per-person excess costs for caregivers and uninsured patients with RA were estimated. Costs were estimated for other burdens, including costs of work-loss to employers, adaptations to home and work environments, lost on-the-job productivity, informal and hired care/household help, and job turnover costs. Intangible costs associated with quality-of-life deterioration were estimated based on legal system jury awards, whereas costs for premature mortality were based on lifetime earnings data. Per-capita cost estimates were weighted by the relevant population to estimate societal costs. Because data were incomplete, several assumptions were required; these assumptions could lead to an over- or under-estimation of cost burdens.Results:Annual excess health care costs of RA patients were 8.4billion, and costs of other RA consequences were 10.9billion. These costs translate to a total annual cost of 19.3billion. From a stakeholder perspective, 33 of the total cost was allocated to employers, 28 to patients, 20 to the government, and 19 to caregivers. Adding intangible costs of quality-of-life deterioration (10.3billion) and premature mortality (9.6billion), total annual societal costs of RA (direct, indirect, and intangible) increased to 39.2billion.Conclusions:Societal costs of RA in the US are 19.3billion and 39.2billion (in 2005 dollars) without and with intangible costs, respectively. This study was one of the first to attempt to quantify the comprehensive burdens of RA. Despite several assumptions made in areas in which few data exist, the findings generate useful insights into the full burden of RA. [ABSTRACT FROM AUTHOR]

Objective: To describe dosing patterns for tumor necrosis factor (TNF) antagonists in patients with rheumatoid arthritis from health care provider and payer point of interest.Research design and methods: Using privately insured US claims data from 31 large employers covering 31 companies across the US, rheumatoid arthritis (RA) patients were identified and three cohorts were defined based on first TNF-antagonist treatment (adalimumab, etanercept, or infliximab) administered after January 1, 2003. Dosageadjustment patterns were assessed during the following 12-month period. Changes in dosage (both increases and decreases) and maintenance of a stable dosage were evaluated. For the health care provider point of interest, a new algorithm was developed to assess treatment patterns with chronic injectable therapies that incorporated the potential inconsistency between days of supply and prescription-gap data, thus providing the actual use of TNFantagonist treatment. For the payer, usage data addressed whether the TNF antagonist was used at a greater dosage than recommended. Differences in baseline characteristics and dosage change rates between cohorts were tested using Chi-Square tests for categorical variables and Wilcoxon tests for continuous variables.Results: From the health care provider point of interest, 83.4% of adalimumab-treated patients (n = 205) initially received the recommended dosage, 10.2% received less, and 6.3% received more; 87.7% of etanercept-treated patients (n = 455) initially received the recommended dosage, 11.2% received less, and 1.1% received more; and 83.8% of infliximab-treated patients (n = 148) started with 2–4 vials (the recommended dosage is based on the weight of the patient, not total milligrams). All treatments had similar dosage decrease and discontinuation rates. Maintenance of stable dosage was lower for infliximab (20.9%) than adalimumab (37.1%) and etanercept (39.1%); both p < 0.01. The infliximab dosage-increase rate (35.1%) was greater than adalimumab (3.9%) and etanercept (0); both p < 0.01. From the payer point of interest, dosage-increase rate was greater for infliximab (28.3%) than adalimumab (8.7%) and etanercept (6.9%), both p < 0.01.Conclusions: Infliximab had greater dosage-increase rates than adalimumab and etanercept. Adalimumab and etanercept had similar dosage-increase rates. All treatments had similar dosage-decrease and discontinuation rates. Maintenance of stable dosage was lower for infliximab than for adalimumab and etanercept. The study has the usual limitation of claims data analysis in that clinical details might be insufficient to draw causal inference. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost of care for rheumatoid arthritis (RA) patients treated with adalimumab, infliximab, and etanercept.Research design and methods: RA patients were identified from a privately insured database. Three mutually exclusive treatment cohorts were formed based on the date of first tumor necrosis factor (TNF) antagonist treatment (index date) after January 1, 2003. Baseline characteristics were assessed in the 3-month pretreatment period. Healthcare (i.e., medical service and prescription medications) utilization and cost were assessed for the following 12 months. RA-related medical cost included the total cost for medical service associated with RA diagnosis. RA-related healthcare cost included RA-related medical and drug cost. Uneven distribution of baseline characteristics were adjusted with the propensity score method. Cost was compared between treatment cohorts.Results: Twelve-month TNF-antagonist therapy cost ($12 853 vs. 17 299, p = 0.002), total RA-related drug cost ($13 794 vs. 17 647, p = 0.006), total RA-related medical cost ($971 vs. 2920, p < 0.001), total RA-related healthcare cost ($14 764 vs. 20 566, p = 0.002), and total drug cost ($16 210 vs. 19 769, p = 0.028) were significantly less for adalimumab (n = 217) than infliximab (n = 234). Twelve-month healthcare cost for adalimumab was comparable to etanercept (n = 546).Conclusions: Annual healthcare cost for adalimumab patients was significantly less than for infliximab patients and was comparable to etanercept patients. This analysis is subject to the usual limitation of claims data analyses in that few clinical details are available and causal inference conclusions are limited. [ABSTRACT FROM AUTHOR]