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The temporal association between hospital admissions, biological therapy usage and direct health care costs in rheumatoid arthritis patients

  • Pharmacoeconomics
  • Published:
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Abstract

The Australian Pharmaceutical Benefits Scheme (PBS) has subsidised biological therapy since 2003. We investigated the association between biological therapy for RA hospitalisation rates and health-care costs.

Hospital admissions for RA patients between 1995 and 2014 were identified in the Western Australia (WA) Hospital Morbidity Data Collection (ICD codes 714 and M05.00–M06.99). State-specific dispensing data for conventional and biological therapies for RA was obtained from Statistics Australia and expressed as defined daily doses/1000 population/day (DDD) using WA population census. Principal component analysis (PCA) was applied to determine the relationship between DMARDs use and hospital admission rates.

A total of 17,125 patients had 50,353 admissions with a diagnostic code for RA. Between 1995 and 2002, the number of RA admissions fell from 7.9 to 2.6/1000 admissions, while conventional therapy use rose from 1.45 to 1.84 DDD. Between 2003 and 2014, RA admissions decreased further to 1.9/1000 hospital admissions, while conventional therapy use increased to 2.19 DDD and biological therapy from 0.01 to 1.0 DDD. In PCA, conventional and biological therapies use had an inverse relationship with hospital admission rates. Annual costs of biological therapy utilisation was 22.5 million in 2003–2014, while the annual cost saving of RA hospital admissions was 9.2 million.

The increased use of conventional therapy use for RA has coincided with a significant decline in hospital admissions for RA patients in WA, while a more modest further decline followed biological therapy introduction. Biological therapy was not as cost-effective as conventional in relation to RA hospital admissions costs.

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Abbreviations

 − :

Cost savings

 + :

Excess costs

ABA:

Abatacept

ADA:

Adalimumab

AIHW:

Australian Institute of Health and Welfare

AZA:

Azathioprine

bDMARD:

Biological disease-modifying anti-rheumatic drugs

cDMARD:

Conventional DMARD

CI:

Confidence interval

CP:

Cyclophosphamide

CsA:

Cyclosporine

CZP:

Certolizumab

DDD:

Defined daily doses

DMARDs:

Disease-modifying anti-rheumatic drugs

ETN:

Etanercept

GOL:

Golimumab

GST:

Sodium aurothiomalate

HCQ:

Hydroxychloroquine

HR:

Hazard ratio

ICD:

International Classification of Diseases

IFX:

Infliximab

IV:

Intravenous

LEF:

Leflunomide

MTX:

Methotrexate

PBS:

Pharmaceutical Benefits Scheme

PC1:

First principal component

PC2:

Second principal component

PCA:

Principal component analysis

PEN:

Penicillamine

RA:

Rheumatoid arthritis

RTX:

Rituximab

SSZ:

Sulphasalazine

TCZ:

Tocilizumab

VIF:

Variance inflation factor

WA:

Western Australia

WARDER:

Western Australian Rheumatic Disease Epidemiological Registry

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Acknowledgements

The authors thank the data custodians of Hospital Morbidity Data Collection and staff at the Western Australian Data Linkage Branch for their assistance in the provision of data. KA was supported by an Australian Government Research Training Program PhD Scholarship at the University of Western Australia and the Australian Rheumatology Association WA Research Fellowship Award.

Funding

WARDER development was supported by an unrestricted grant from the Arthritis Foundation of Western Australia.

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Authors and Affiliations

  1. School of Medicine, The University of Western Australia, Perth, Western Australia, Australia

    Khalid Almutairi, Johannes Nossent, Helen Keen & Charles Inderjeeth

  2. King Fahd Specialist Hospital, Burydah, AlQassim, Saudi Arabia

    Khalid Almutairi

  3. Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Western Australia, Australia

    Johannes Nossent & Charles Inderjeeth

  4. School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia

    David B. Preen

  5. Fiona Stanley Hospital, Murdoch, Western Australia, Australia

    Helen Keen

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Contributions

All authors made substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data; and the drafting of the manuscript or revising it critically for important intellectual content. The first draft of the manuscript was written by KA, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript to be published and agreed to take accountability for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Khalid Almutairi.

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Ethic approval for this study was granted by the WA Department of Health Human Research Ethics Committee (approval number 2016/24) and the Human Research Ethics Committee of the University of Western Australia (approval number RA/4/20/4070).

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Almutairi, K., Nossent, J., Preen, D.B. et al. The temporal association between hospital admissions, biological therapy usage and direct health care costs in rheumatoid arthritis patients. Rheumatol Int 42, 2027–2037 (2022). https://doi.org/10.1007/s00296-021-04985-2

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