PSY1 Medication Trends and Medical Costs Among Patients with Rheumatoid Arthritis on Biologics Treatment in Taiwan: A 6-Year Cohort Study Using a National Claims Database

This nationwide population-based study aimed at evaluating medication trends and direct medical costs among rheumatoid arthritis (RA) patients receiving biologic therapies in Taiwan. A retrospective cohort of 14,651 patients who had at least one primary or secondary diagnosis of RA and received initial biologics treatments in outpatient services between January 1, 2011 and December 31, 2017 were identified from the National Health Insurance Research Database in Taiwan. After excluding ineligible patients, 5,854 patients were included in the analysis. Trends and distributions of biologics treatments and direct medical costs (including all-cause costs and RA-related costs) of those patients were analyzed. Results showed that among those 5,854 patients etanercept (n = 1,681, 28.7%) was prescribed the most by their physicians, followed by adalimumab (n = 1,428, 24.4%), while rituximab (n = 132, 2.3%) was administered the least. Notably, after physicians in Taiwan started to prescribe tocilizumab in year 2012 and tofacitinib in 2015, the proportions of tocilizumab and tofacitinib users had increased substantially. On the contrary, users of etanercept and adalimumab had decreased markedly. As regards direct medical costs, results revealed that among various types of biologics treatments, golimumab incurred the highest total medical costs, while tocilizumab cost the least during the 1-year follow-up (all p-values < 0.0001). Lastly, pertaining to RA-related costs, the same cost patterns were observed, including biologic costs per se. Stated differently, golimumab cost the most and tocilizumab took up the smallest amount of medical expenses (all p-values < 0.0001). This real-world analysis demonstrated that most RA patients in Taiwan were treated with etanercept. Treatment of golimumab incurred the highest total medical costs, while tocilizumab cost the least. Furthermore, there is a rapidly growing popularity of tofacitinib and tocilizumab treatments, perhaps due to their relatively low costs and/or better mechanisms, which await further substantiation.