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Switching SC-TNFi Associated With Higher Nontreatment HCRU Costs

July 16, 2020

Patients with inflammatory arthritis who switched from a first-line to a second-line subcutaneous tumor necrosis factor alpha inhibitor (SC-TNFi) incurred significantly higher nontreatment health care resource utilization (HCRU) costs 12 months after the switch. Patients who stayed with their first-line treatment, however, significantly lowered their costs during the same period.  

Researchers published their findings online in Advances in Therapy.

“While a switch from a first-line to a second-line SC-TNFi treatment may be well motivated from a clinical viewpoint, the costs associated with switching treatments are largely unknown,” researchers wrote in the study introduction. 

The retrospective observational study included 594 biologic-naïve patient pairs in Sweden treated with an SC-TNFi (adalimumab, etanercept, certolizumab, or golimumab) for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis—collectively categorized as inflammatory arthritis—between May 6, 2010, and December 31, 2014. Patients who switched SC-TNFi treatment were matched with patients who persisted with their first-line SC-TNFi based on propensity score and follow-up time. Researchers compared HCRU-associated costs 12 months before and 12 months after the switch, or index, date.

Patients who switched treatments had significantly higher nontreatment HCRU costs ($3815) before the switch date compared with patients who persisted with their treatment ($2900), according to the study. Yet 12 months after the switch date, patients who switched treatments had increased their nontreatment HCRU costs by $822, while patients who persisted with the original treatment lowered their nontreatment costs by $313.

At $1135, the difference in difference between the groups was statistically significant, researchers pointed out. Costs for specialized outpatient care and inpatient care largely drove the difference. 

“As these findings indicate that differences in treatment persistence may have an impact on costs, further research utilizing more comprehensive data sources in alternate settings is warranted,” researchers advised. 

Jolynn Tumolo 


Dalén J, Luttropp K, Svedbom A, Black CM, Kachroo S. Healthcare-Related Costs Associated with Switching Subcutaneous Tumor Necrosis Factor-α Inhibitor in the Treatment of Inflammatory Arthritis: a Retrospective Study [published online ahead of print, 2020 Jul 9]. Adv Ther. 2020;10.1007/s12325-020-01425-8. doi:10.1007/s12325-020-01425-8

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