Diabetes-Related Complications and Costs in Medicare Beneficiaries with Comorbid Rheumatoid Arthritis and Diabetes Treated with Abatacept Versus Other Targeted DMARDs

Vardhaman Patel; Zulkarnain Pulungan; Anne Shah; Barton Jones; Allison Petrilla; Leticia Ferri; Xue Han; Kaleb Michaud

doi:10.1007/s40744-022-00453-w

Diabetes-Related Complications and Costs in Medicare Beneficiaries with Comorbid Rheumatoid Arthritis and Diabetes Treated with Abatacept Versus Other Targeted DMARDs

Rheumatol Ther. 2022 Aug;9(4):1091-1107. doi: 10.1007/s40744-022-00453-w. Epub 2022 May 23.

Authors

Vardhaman Patel¹, Zulkarnain Pulungan², Anne Shah², Barton Jones², Allison Petrilla², Leticia Ferri³, Xue Han³, Kaleb Michaud^{4

5}

Affiliations

¹ Bristol Myers Squibb, Lawrence Township, NJ, USA. vardhaman.patel@bms.com.
² Avalere Health, Washington, DC, USA.
³ Bristol Myers Squibb, Lawrence Township, NJ, USA.
⁴ University of Nebraska Medical Center, Omaha, NE, USA.
⁵ Forward, The National Databank for Rheumatic Diseases, Wichita, KS, USA.

Abstract

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.

Keywords: Abatacept; DMARD; Healthcare resource utilization; Rheumatoid arthritis; Type 2 diabetes mellitus.