Effect of dose tapering policy on the prescription of advanced therapy for rheumatoid arthritis: a retrospective analysis of clinical and cost outcomes in Taiwan

Aim: To evaluate the impact of the Taiwan National Health Insurance program policy for advanced rheumatoid arthritis (aRA) therapies on treatment prescription patterns and costs in patients with rheumatoid arthritis (RA). Materials & methods: We performed a retrospective analysis of patients with RA aged ≥18 years who had commenced aRA treatment in the National Health Insurance research database in Taiwan between 2011 and 2017. Follow-up data were aggregated every 3 months to determine the proportion of the covered RA prescription days and the medical cost. Associations of the tapering policy initiation in 2014, aRA dose, non-aRA prescription and cost were analyzed using a generalized linear model. Results: In total, 9099 patients with RA were included in this study. Before the policy implementation, the probability of aRA dose tapering increased significantly once treatment duration reached 24 months, with adjusted odds ratio = 3.27 (p < 0.001); this further increased to 4.00 (p < 0.001) after the policy was implemented. The difference between both adjusted odds ratios was statistically significant (p = 0.012). Dose tapering for aRA was associated with reduced medical costs and decreased use of other RA prescription drugs. However, the number of reductions decreased after the dose tapering policy was initiated, suggesting an unintended effect of the policy. Conclusion: The policy implementation increased the dose tapering of aRA prescriptions and was associated with decreased medication costs and the use of other RA treatments. However, a moderate partial offset of the reduction in outcome measures suggests unintended consequences of the policy.