Improved Health Outcomes in Patients Receiving Health Case Management
- Belinda Yap, Manager, Health Economics and Outcomes Research, Innomar Strategies
- Yulia Krupitsky, Program Manager, HealthForward
- Tara Liu, Director, Drug Strategy, Great-West Life Assurance Company
- Phil Peters, Director of Pharmacy and Payer Strategy, HealthForward
- Alison Drinkwater, Senior Director, Strategic Consulting, Innomar Strategies
- Sandra Anderson, Vice President, Consulting and Business Development, Innomar Strategies
- Kevin West, Vice President, HealthForward
To demonstrate that health case management (HCM) administered with routine care (RC) delivers better health outcomes than RC alone. HCM is a Great-West Life program aimed at monitoring health outcomes and managing costs of certain specialty drugs. Data from two HCM cohorts – i) Rheumatoid arthritis (RA) patients on adalimumab, and ii) Psoriatic arthritis (PsA) patients receiving etanercept, were compared to with published real-world observational data of Canadian RA and PsA patients treated with adalimumab and etanercept, respectively.
Two published studies were identified for comparison with HCM RA on adalimumab: Study 1-NCT01585064 and Study 2-NCT01117480. HCM PsA on etanercept was compared with Study 3–NCT00127842. From June 2012 to December 2016, 99 RA and 31 PsA HCM patients were eligible for data analysis. In RA patients on adalimumab, unadjusted comparisons demonstrated a higher reduction in Health Assessment Questionnaire–Disability Index (HAQ-DI) score over 6 months for HCM compared with RC (0.97 versus 0.47 [study 1], P < 0.001; and 0.97 versus 0.31 [study 2], P < 0.001).
The percentage of patients achieving low disease activity after 6 months was higher in HCM than RC (54.1% versus 28.4% [study 1], P = 0.005). Similarly, the percentage of patients achieving remission after six months was higher in HCM than RC (45.9% versus 17.4% [study 1], P = 0.001; and 45.9% versus 13.0% [study 2], P < 0.001). In PsA patients on etanercept, a higher percentage of HCM patients achieved HAQ-DI reductions of ≥ 0.5 points after six months compared with RC (84% versus 62% [study 3], P = 0.025). This analysis demonstrates the benefit of HCM in improving health outcomes over RC alone, and helps inform future HCM prospective studies.