When patients with rheumatoid arthritis experience failure of an anti–tumor necrosis factor (anti-TNF) therapy, clinical guidelines support either cycling to a different anti-TNF agent or switching to a treatment with a different method of action (MOA). However, payers often require cycling of anti-TNF options before they will reimburse for treatments with a different MOA.
When patients with rheumatoid arthritis (RA) experience failure of an anti—tumor necrosis factor (anti-TNF) therapy, clinical guidelines support either cycling to a different anti-TNF agent or switching to a treatment with a different method of action (MOA). However, payers often require cycling of anti-TNF options before they will reimburse for treatments with a different MOA. Yet, according to a recent study, switching to a drug with a different MOA is associated with higher treatment persistence and lower healthcare costs.
The retrospective study, published in Advances in Therapy, used de-identified commercial claims data and Medicare Advantage claims data from the Optum Research Database. Patients (n = 1516) had at least 1 claim for an anti-TNF drug (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) between January 2012 and September 2015. Included patients changed therapy to a different targeted agent during the 1-year period following their first anti-TNF claim. Patients who switched to a different method of action (n = 581) were 38.3% of the population, while those who cycled to a different anti-TNF (n = 935) comprised 61.7%.
The study found that:
When costs were divided by treatment persistence rates, the estimated cost per patient for a 1-year follow-up period were lower for MOA switchers versus anti-TNF cyclers, with $25,436 lower total RA-related costs per persistent patient, and $25,999 lower targeted drug costs per persistent patient.
The researchers noted that their study is limited by the fact that no reasons for discontinuation of therapy (such as adverse events, lack of efficacy, cost burden, or even the achievement of clinical remission) were provided, nor were clinical outcomes data (including disease severity). Additionally, drug costs in claims data do not take into account discounts or rebates.
However, the authors conclude that patients who switched to a different MOA had higher treatment persistence and lower healthcare costs than those who cycled to a different anti-TNF agent, and that reimbursement policies that require anti-TNF product cycling “may result in suboptimal outcomes for both patients and payers.”