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Tachkov K, Boyadzhieva V, Manev I, Stoilov N, Mitkova Z, Mitov K, Petrova G. Cost of arthropathic diseases therapy with biologicals disease modifying drugs (bDMARs): a 5-year cost analysis at national level. BIOTECHNOL BIOTEC EQ 2022. [DOI: 10.1080/13102818.2022.2131468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Konstantin Tachkov
- Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Vladimira Boyadzhieva
- Department of Rheumatology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Sofia, Bulgaria
| | - Ivan Manev
- Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Nikolay Stoilov
- Department of Rheumatology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Mitov
- Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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Frantzen L, Cohen JD, Tropé S, Beck M, Munos A, Sittler MA, Diebolt R, Metzler I, Sordet C. Patients' information and perspectives on biosimilars in rheumatology: A French nation-wide survey. Joint Bone Spine 2019; 86:491-496. [PMID: 30659920 DOI: 10.1016/j.jbspin.2019.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/16/2018] [Accepted: 01/03/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the patients' information about biosimilars and to identify the patients' incentives and deterrents to concur with the use of biosimilars. METHODS Nation-wide cross-sectional study assessing information and concerns about biosimilars of French patients treated for rheumatic inflammatory diseases, whether they were treated or not by a biological DMARD. The assessment was available online from March to July 2017. RESULTS Among the 629 respondents, 43% knew what biosimilars were. The main sources of information were rheumatologists and patient associations. Among patients treated with a biosimilar, 44% were not informed before they received the treatment. The patients' concerns focused on the non-similar molecular structure (46%), efficacy (60%) and safety (57%) comparatively to the originator biologic. 15% of respondents would refuse to switch their biologic to its biosimilar. More than 50% of respondents would warily accept to switch medications and interrupt the treatment if in doubt. Being informed about biosimilars and a good understanding of the definition of biosimilars were characteristics associated with better adherence to biosimilars. The rheumatologist was considered the most influent source of information about biosimilars and was considered reliable when deciding to switch a biologic to its biosimilar. Patient were reluctant to substitution of the medications by pharmacists (2%). Medico-economical issues acted as an incentive and a deterrent to accept the switch of medication. CONCLUSION Biosimilars are largely unknown to patients. Information seems to be instrumental in improving the patients' adherence to biosimilars and could help preserving the therapeutic relationship and avoiding a nocebo effect.
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Affiliation(s)
- Léa Frantzen
- Rheumatology department, hôpital Emile-Muller, GHR Mulhouse Sud Alsace, 20, rue du Dr René-Laennec 68051 Mulhouse, France.
| | - Jean-David Cohen
- Rheumatology department, hôpital Lapeyronie, centre hospitalier universitaire de Montpellier, 371, avenue du doyen Gaston-Giraud, 34295 Montpellier, France
| | - Sonia Tropé
- Association nationale de défense contre l'arthrite rhumatoïde, 160, avenue de Fes 34080 Montpellier, France
| | - Morgane Beck
- OMEDIT agence régionale de santé Grand Est, 14, rue du Maréchal-Juin 67000 Strasbourg, France
| | - Audrey Munos
- Institut des métiers et des technologies, 38, avenue Marcel-Dassault 37206 Tours, France
| | - Marie-Annick Sittler
- Rheumatology department, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Rita Diebolt
- Association France Spondylarthrite, Section Alsace, hôpital de Hautepierre, 1 avenue Molière, 67098 Strasbourg, France
| | - Isabelle Metzler
- Association France Spondylarthrite, Section Alsace, hôpital de Hautepierre, 1 avenue Molière, 67098 Strasbourg, France
| | - Christelle Sordet
- Rheumatology department, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
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Nergard-Martin J, Siddiqui F, Kailas A, Winslow M, Solomon JA. Why Outcome Measures in Dermatology Are Becoming Patient Centric. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schwartzman S, Li Y, Zhou H, Palmer JB. Economic impact of biologic utilization patterns in patients with psoriatic arthritis. Clin Rheumatol 2017; 36:1579-1588. [PMID: 28474139 PMCID: PMC5486473 DOI: 10.1007/s10067-017-3636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/16/2022]
Abstract
The aim of the study is to examine the frequency and costs associated with above-label dosing of biologics in patients with psoriatic arthritis (PsA). MarketScan identified adults with ≥1 International Classification of Diseases, Clinical Modification diagnosis for PsA and ≥1 pharmacy claim for biologics of interest between January 1, 2011 and December 31, 2013. The first biologic claim was the index date with a 1-year follow-up period and three additional months to confirm continuous biologic use. Exclusion criteria included switching to a different biologic or diagnosis with another autoimmune disease. During the follow-up period, duration was stratified into three groups: <30, 30–179, and ≥180 days of above-label dosing (>10% of the labeled dose). One-tailed t test was conducted to examine the impact of above-label duration on healthcare costs. We identified 4245 PsA patients receiving etanercept (n = 2342), adalimumab (n = 1788), and golimumab (n = 115). Above-label dosing of <30 days (85% adalimumab, 90.4% etanercept, and 95.7% golimumab) and ≥180 days (9.6% adalimumab, 4.1% etanercept, and 2.6% golimumab) was observed. All-cause total healthcare costs for <30 days of above-label use (etanercept $30,625, adalimumab $31,620, and golimumab $37,224), 30–179 days (etanercept $35,602, adalimumab $38,915, and golimumab $64,349), and ≥180 days (etanercept $55,349, adalimumab $54,176, and golimumab $47,993) were reported. Longer above-label duration (30–179 versus <30 days, ≥180 versus 30–179 and ≥180 days) with etanercept or adalimumab was significantly associated with higher mean increased total all-cause healthcare, PsA-specific healthcare, and biologic costs (p < 0.05). Above-label use of anti-TNF biologics does occur and is associated with significantly increased healthcare costs.
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Affiliation(s)
- Sergio Schwartzman
- The Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
| | - Yunfeng Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Reijers JAA, van Donge T, Schepers FML, Burggraaf J, Stevens J. Use of population approach non-linear mixed effects models in the evaluation of biosimilarity of monoclonal antibodies. Eur J Clin Pharmacol 2016; 72:1343-1352. [PMID: 27515979 PMCID: PMC5055907 DOI: 10.1007/s00228-016-2101-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/13/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Population pharmacokinetic analyses (PPK) have been used to establish bioequivalence for small molecules and some biologicals. We investigated whether PPK could also be useful in biosimilarity testing for monoclonal antibodies (MAbs). METHODS Data from a biosimilarity trial with two trastuzumab products were used to build population pharmacokinetic models. First, a combined model was developed and similarity between test and reference product was evaluated by performing a covariate analysis with trastuzumab drug product (test or reference) on all model parameters. Next, two separate models were developed, one for each drug product. The model structure and parameters were compared and evaluated for differences. RESULTS Drug product could not be identified as statistically significant covariate on any parameter in the combined model, and the addition of drug product as covariate did not improve the model fit. A similar structural model described both the test and reference data best. Only minor differences were found between the estimated parameters from these separate models. CONCLUSIONS PPK can also be used to support a biosimilarity claim for a MAb. However, in contrast to the standard non-compartmental analysis, there is less experience with a PPK approach. Here, we describe two methods of how PPK can be incorporated in biosimilarity testing for complex therapeutics.
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Affiliation(s)
- Joannes A A Reijers
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
| | - T van Donge
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - F M L Schepers
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - J Stevens
- Centre for Human Drug Research (CHDR), Zernikedreef 8, 2333 CL, Leiden, The Netherlands
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Gu T, Shah N, Deshpande G, Tang DH, Eisenberg DF. Comparing Biologic Cost Per Treated Patient Across Indications Among Adult US Managed Care Patients: A Retrospective Cohort Study. Drugs Real World Outcomes 2016; 3:369-381. [PMID: 27757919 PMCID: PMC5127933 DOI: 10.1007/s40801-016-0093-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The relative cost of biologics in the treatment of autoimmune disorders, including rheumatoid arthritis, psoriatic arthritis, psoriasis, and ankylosing spondylitis, is a key consideration for managed care payers. OBJECTIVES Our objective was to estimate biologic costs and treatment patterns in US managed care patients with rheumatoid arthritis, psoriatic arthritis, psoriasis, and/or ankylosing spondylitis. METHODS This retrospective study used administrative claims data from the HealthCore Integrated Research Database (HIRDSM) for adults with rheumatoid arthritis, psoriatic arthritis, psoriasis, and/or ankylosing spondylitis who received abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab between 1 July 2009 and 31 January 2013. Biologic costs (based on drug utilization) and treatment patterns (discontinued, restarted after a >45-day gap, switched to another biologic, or persisted without switching or stopping) were analyzed for the first year post-index. RESULTS Most of the 24,460 patients received etanercept (48 %), adalimumab (29 %), or infliximab (12 %) as the index biologic. On the index date, 44 % were new to biologic therapy and 56 % were continuing biologic therapy. Biologic cost per treated patient for 1 year was as follows: etanercept $US24,859, adalimumab $US26,537, and infliximab $US26,468. Treatment patterns across indications for etanercept, adalimumab, and infliximab were as follows: persistent (52, 49, 67 %), restarted (23, 21, 12 %), switched (12, 13, 11 %), and discontinued (14, 18, 10 %). CONCLUSIONS These findings from a large health benefits organization in the USA are similar to those of several previous cost analyses assessing different populations, which demonstrates the external validity of the results from the previous studies, both over time and across large populations.
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Affiliation(s)
- Tao Gu
- HealthCore, Inc., 123 S. Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA.
| | | | - Gaurav Deshpande
- HealthCore, Inc., 123 S. Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
| | | | - Debra F Eisenberg
- HealthCore, Inc., 123 S. Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
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Cannon GW, DuVall SL, Haroldsen CL, Caplan L, Curtis JR, Michaud K, Mikuls TR, Reimold A, Collier DH, Joseph GJ, Harrison DJ, Sauer BC. Clinical Outcomes and Biologic Costs of Switching Between Tumor Necrosis Factor Inhibitors in US Veterans with Rheumatoid Arthritis. Adv Ther 2016; 33:1347-59. [PMID: 27352377 PMCID: PMC4969320 DOI: 10.1007/s12325-016-0371-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Indexed: 11/26/2022]
Abstract
Introduction The purpose of this study was to evaluate clinical outcomes and drug/administration costs of treatment with tumor necrosis factor inhibitor (TNFi) agents in US veterans with rheumatoid arthritis (RA) initiating TNFi therapy. The analysis compared patients initiating and continuing a single TNFi with patients who subsequently switched to a different TNFi. Methods Data from patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry who initiated treatment with adalimumab, etanercept, or infliximab from 2003 to 2010 were analyzed. Outcomes included duration of therapy, Disease Activity Score based on 28 joints (DAS28), and direct drug and drug administration costs. Results Of 563 eligible patients, 262 initiated a single TNFi therapy, 142 restarted their initial TNFi after a ≥90-day gap in treatment (interrupted therapy), and 159 switched to a different TNFi. Patients who switched had higher mean DAS28 before starting TNFi therapy than patients with single or interrupted therapy: 5.3 vs 4.5 or 4.6, respectively. Mean duration of the first course was 34.3 months for single therapy, 18.3 months for interrupted therapy, and 17.7 months for switched therapy. Mean post-treatment DAS28 was highest for patients who switched TNFi. Mean annualized costs for first course were $13,800 for single therapy, $13,200 for interrupted therapy, and $14,200 for switched therapy; mean annualized costs for second course were $12,800 for interrupted therapy and $15,100 for switched therapy. Conclusion Patients who switched TNFi had higher pre-treatment DAS28 and higher overall costs than patients who received the same TNFi as either single or interrupted therapy. Funding This research was funded by Immunex Corp., a fully owned subsidiary of Amgen Inc., and by VA HSR&D Grant SHP 08-172.
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Affiliation(s)
- Grant W Cannon
- Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Scott L DuVall
- Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Candace L Haroldsen
- Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Liron Caplan
- Denver VA and University of Colorado School of Medicine, Denver, CO, USA
| | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA
- National Data Bank for Rheumatic Diseases, Wichita, KS, USA
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA
| | - Andreas Reimold
- Dallas VA and University of Texas Southwestern, Dallas, TX, USA
| | | | | | | | - Brian C Sauer
- Veterans Affairs Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
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Palmer JB, Li Y, Herrera V, Liao M, Tran M, Ozturk ZE. Treatment patterns and costs for anti-TNFα biologic therapy in patients with psoriatic arthritis. BMC Musculoskelet Disord 2016; 17:261. [PMID: 27301458 PMCID: PMC4908678 DOI: 10.1186/s12891-016-1102-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 05/27/2016] [Indexed: 01/21/2023] Open
Abstract
Background Real-world data regarding anti-tumor necrosis factor alpha (anti-TNFα) biologic therapy use in psoriatic arthritis (PsA) are limited; therefore, we described treatment patterns and costs of anti-TNFα therapy in PsA patients in the United States. Methods PsA patients (N = 990) aged ≥18 years who initiated anti-TNFα therapy were selected from MarketScan claims databases (10/1/2009 to 9/30/2010). Number of patients on first- (n = 881), second- (n = 72), or third- or greater (n = 37) line of anti-TNFα therapy, persistence, time-to-switch or modification, pharmacy and medical costs (measured per patient per month [PPPM]) for each line of therapy were observed during the 3-year follow-up. Results PsA patients receiving only one line of anti-TNFα therapy remained on first-line for ~17 months while those who switched to second- or third- or greater persisted on first-line for ~11 to 12 months, respectively. Time to first-line modification was longer for patients who switched to third- or greater line therapy (7 months) than those who did not switch or switched to second-line (range, ~2 to 4 months). Time-to-switch and time to first-line modification was progressively shorter with each line of therapy for patients who received third- or greater line. PPPM medical costs were higher for patients who did not switch ($322) than those who switched to second- ($167) or third- or greater ($217) line. PPPM pharmacy costs were greater for patients with third- or greater line therapy ($2539) than those who did not switch ($1985) or switched to second-line ($2045). Conclusion While the majority of patients received only one line of anti-TNFα therapy, a subset of patients switched to multiple lines of therapy during the 3-year follow-up period. Persistence and therapy modifications differed between these patients and those receiving only one line. Overall medical costs were highest for patients who did not switch, and pharmacy costs increased as patients switched to each new line of therapy.
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Affiliation(s)
- Jacqueline B Palmer
- Immunology and Dermatology, Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA.
| | - Yunfeng Li
- Outcomes Research Methods & Analytics, US Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936-1080, USA
| | - Vivian Herrera
- Immunology and Dermatology, Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
| | - Minlei Liao
- KMK Consulting, Inc, Morristown, NJ, 07960-1080, USA
| | - Melody Tran
- Immunology and Dermatology, Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA.,Scott & White Health Plan, Temple, TX/College of Pharmacy, The University of Texas at Austin, Austin, TX, 78705, USA
| | - Zafer E Ozturk
- Immunology and Dermatology Medical Affairs Department, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936-1080, USA
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A Retrospective Cohort Study Comparing Utilization and Costs of Biologic Therapies and JAK Inhibitor Therapy Across Four Common Inflammatory Indications in Adult US Managed Care Patients. Adv Ther 2016; 33:626-42. [PMID: 26970958 PMCID: PMC4846706 DOI: 10.1007/s12325-016-0312-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Indexed: 11/30/2022]
Abstract
Introduction Biologic therapies are used to treat several inflammatory diseases, including rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Data from a commercial claims database were used to evaluate utilization and cost of biologic treatment for these conditions. Methods Data were obtained from the Optum Research Database. Patients were aged 18–63 years with diagnosis of moderate to severe RA, PsO, PsA, and/or AS and first (index) claim for biologics abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab or non-biologic tofacitinib between March 1, 2011 and February 28, 2013. One-year treatment costs were based on observed paid amounts and used to impute dosing. Treatment patterns (persistence, switching, discontinuing, restarting) were evaluated. Results Data from 20,159 patients were analyzed for index medications abatacept (n = 583), adalimumab (n = 6521), certolizumab pegol (n = 415), etanercept (n = 9116), golimumab (n = 231), infliximab (n = 1906), rituximab (n = 295), tocilizumab (n = 165), ustekinumab (n = 922), and tofacitinib (n = 5). For patients with RA only, costs were lowest for tofacitinib ($18,769), rituximab ($19,569), or abatacept ($21,877), and ranged from $23,682 to $30,269 for all other medications. For patients with PsO only, costs were lowest for adalimumab ($29,186), etanercept ($31,212), and infliximab ($32,409) compared with ustekinumab ($53,746). For patients with PsA only, costs were lowest for etanercept ($26,916), followed by golimumab ($27,987), adalimumab ($28,749), and infliximab ($31,974). Costs were lowest with etanercept for RA plus PsA ($25,477) and for PsO plus PsA ($29,376), and with golimumab for AS only ($24,225). Across indications, annual costs were $29,521, $27,488, and $28,672 for adalimumab, etanercept, and infliximab, respectively; persistence was greatest with infliximab (range 66–79%) compared with 11–59% for all other biologics. Conclusion One-year treatment costs varied considerably between medications and indications. Some newly approved agents had lower costs but further research is needed to confirm these estimates as more patients are treated. Funding Immunex (a wholly owned subsidiary of Amgen Inc.) and Wyeth (acquired by Pfizer).
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Cantini F, Niccoli L, Nannini C, Cassarà E, Kaloudi O, Giulio Favalli E, Becciolini A, Biggioggero M, Benucci M, Li Gobbi F, Grossi V, Infantino M, Meacci F, Manfredi M, Guiducci S, Bellando-Randone S, Matucci-Cerinic M, Foti R, Di Gangi M, Mosca M, Tani C, Palmieri F, Goletti D. Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. Semin Arthritis Rheum 2016; 45:519-32. [DOI: 10.1016/j.semarthrit.2015.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 02/08/2023]
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Sauer BC, Teng CC, He T, Leng J, Lu CC, Walsh JA, Shah N, Harrison DJ, Tang DH, Cannon GW. Treatment patterns and annual biologic costs in US veterans with rheumatic conditions or psoriasis. J Med Econ 2016; 19:34-43. [PMID: 26337538 DOI: 10.3111/13696998.2015.1086774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine annual biologic drug and administration costs to the US Veterans Health Administration (VHA) per treated patient with rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who received abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab. METHODS Adults with at least one biologic claim between January 1, 2008 and December 31, 2011 were included. Evidence of enrollment in the VHA was required from 365 days before (pre-index) to 360 days after (post-index) the date of the first biologic claim (index date). Included patients had pre-index diagnoses of RA, PsO, PsA, and/or AS. Drug costs were from Federal Supply Schedule or 'Big Four' in November 2014. Administration costs were VHA fixed costs for infused ($169) and subcutaneous ($25) biologics. RESULTS Of the 20,465 patients in the analysis, 10,711 received etanercept, 7838 received adalimumab, and 1196 received infliximab as the index biologic. In these patients, across all uses studied, the VHA incurred greater annual cost per treated patient for infliximab ($18,066) compared with adalimumab ($16,523) and etanercept ($16,526). In the first year post-index, ∼80% of patients were either persistent on these index biologics or re-started these index biologics after a ≥45-day treatment gap. Other biologics comprised <5% of the study population, with sample sizes ranging from 3-374 patients each. Cost by indication for biologics used by >20 patients ranged from $15,056 (etanercept) to $17,050 (abatacept) for RA; $16,697 (adalimumab) to $33,163 (ustekinumab) for PsO; $15,035 (etanercept) to $20,465 (infliximab) for PsA; and $14,239 (etanercept) to $18,536 (infliximab) for AS. LIMITATIONS The model was limited to the VHA. Results for biologics other than adalimumab, etanercept, and infliximab were difficult to interpret because of small sample sizes. CONCLUSIONS Infliximab has higher cost to the VHA than adalimumab or etanercept.
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Affiliation(s)
- Brian C Sauer
- a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA
| | - Chia-Chen Teng
- a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA
| | - Tao He
- a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA
| | - Jianwei Leng
- a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA
| | - Chao-Chin Lu
- a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA
| | - Jessica A Walsh
- b b Rheumatology, SLC VA Medical Center and University of Utah , Salt Lake City , UT , USA
| | - Neel Shah
- c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA
| | - David J Harrison
- c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA
| | - Derek H Tang
- c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA
| | - Grant W Cannon
- b b Rheumatology, SLC VA Medical Center and University of Utah , Salt Lake City , UT , USA
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Bonafede M, Johnson BH, Princic N, Shah N, Harrison DJ. Cost per patient-year in response using a claims-based algorithm for the 2 years following biologic initiation in patients with rheumatoid arthritis. J Med Econ 2015; 18:376-89. [PMID: 25530318 DOI: 10.3111/13696998.2014.1001849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate cost per patient-year in response during 2 years following biologic initiation among patients with rheumatoid arthritis (RA). METHODS Adults newly initiating biologics for RA (etanercept, abatacept, adalimumab, certolizumab, golimumab, or infliximab) between January 2009 and July 2011 were identified in the MarketScan Commercial Database. Eligible patients were continuously enrolled 6 months before (pre-index) and 24 months after (post-index) their first (index) biologic claim. Biologic effectiveness was assessed using six criteria during 2-year follow-up: treatment adherence ≥80%, no biologic dose escalation, no biologic switch, no new disease-modifying anti-rheumatic drug, no new/increased glucocorticoid dose, and limited intra-articular joint injections (≤2). After a 90-day period of non-response for a treatment failure, effectiveness or failure of subsequent treatment was assessed again for the index biologic or new biologic (after switching). Post-index RA-related medical, pharmacy, and drug administration costs were attributed to the index biologic. Cost per patient-year in response was calculated as RA-related costs divided by duration of response. RESULTS Overall, 15.0% of patients (1229/8193) did not fail any criterion for 2 years and were effectively treated. Mean duration of response was highest for etanercept (538.3 days), followed by golimumab (537.0 days; p = 0.864), adalimumab (534.7 days; p = 0.301), certolizumab (524.0 days; p = 0.165), infliximab (480.0 days; p < 0.001), and abatacept (482.3 days; p < 0.001). Total disease-related cost per patient-year in response was lower for patients initiated on etanercept ($25,086) than for patients initiated on adalimumab ($25,960), certolizumab ($26,339), golimumab ($26,332), abatacept ($35,581), or infliximab ($36,107). LIMITATIONS This study was limited to employer-paid commercial insurance. Database analyses cannot determine reasons for failing criteria. The algorithm was not designed and validated for 2 years of follow-up. CONCLUSIONS An effectiveness algorithm estimated that initiating etanercept was the most effective treatment during 2 years of follow-up, with the lowest cost per patient-year in response.
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Abstract
Ethical dilemmas arise with regularity, indeed daily, in the practice of rheumatology. As such, the practitioner must have the sensitivity and capacity to recognize them, reflect on their implications, and formulate responses directed at their mitigation. This article presents relevant ethical considerations (old and new) arising in the contemporary practice of rheumatology. A number of considerations stand out for their relevance to the rheumatic diseases. Conspicuous among these are the high costs associated with modern antirheumatic therapy, the complex relationship between physicians and the pharmaceutical industry, as well as challenges to the provision of care to patients suffering from complex chronic diseases. In this regard, patient autonomy is discussed, as is the need to insure for the provision of the time and resources for adequate patient education. The importance of such concerns goes beyond the patients' themselves extending to the future generation of physicians who we will educate.
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Affiliation(s)
- Emily J Mckeown
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1-400, Toronto, ON, M4N 3M5, Canada,
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14
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Johnston SS, McMorrow D, Farr AM, Juneau P, Ogale S. Comparison of Healthcare Costs Between Rheumatoid Arthritis Patients Treated with Infused Biologics After Switching from Another Biologic. Drugs Real World Outcomes 2015; 2:99-109. [PMID: 27747619 PMCID: PMC4883205 DOI: 10.1007/s40801-015-0018-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction While there is a substantial body of literature on the comparative healthcare costs of biologics used to treat rheumatoid arthritis (RA), nearly all of these investigations have been exclusively focused on anti-tumor necrosis factor-α (anti-TNF) agents in the setting of first-line biologic treatment. This study compared healthcare costs between RA patients treated with infused biologics after previously using at least one other biologic agent. Methods Using a large US administrative claims dataset, adult RA patients initiating an infused biologic (abatacept, infliximab, tocilizumab) between January 1, 2010 and January 1, 2012 (initiation = index) were identified. Rituximab was excluded because of unique dosing intervals, which make it difficult to determine treatment discontinuation using a claims database. Patients were required to have used one or more other biologic (infused or injected) at any time before index. Patients could contribute multiple observations to the dataset; one for each infused biologic they initiated between January 1, 2010 and January 1, 2012. A 6-month period before index was used to measure patient characteristics. A variable-length follow-up period after index was used to measure per-patient per-month (PPPM) healthcare costs, including biologic costs, RA-related healthcare costs, and all-cause healthcare costs. Generalized estimating equations models compared healthcare costs between the biologic agents, adjusting for patients’ demographics and clinical characteristics. Results The sample comprised 3,771 infused biologic initiations (abatacept = 1,759; infliximab = 922; tocilizumab = 1,090); the mean age of participants was 55 years, 82 % were female, and the median follow-up ranged from 251 to 280 days. Compared with other patients, patients treated with tocilizumab had significantly lower (all P < 0.05) PPPM biologic costs (abatacept = $2,597, infliximab = $3,141, tocilizumab = $1,894), RA-related healthcare costs (abatacept = $2,929, infliximab = $3,598, tocilizumab = $2,236), and all-cause healthcare costs (abatacept = $3,735, infliximab = $4,600, tocilizumab = $3,042). Conclusions Among RA patients treated with infused biologics after previously using at least one other biologic, patients treated with tocilizumab had the lowest real-world healthcare costs, largely driven by lower costs directly related to biologic treatment. Such biologic-related cost differences may be driven by variations in real-world treatment patterns (e.g., dose, escalation, treatment frequency).
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Affiliation(s)
- Stephen S Johnston
- Truven Health Analytics, 7700 Old Georgetown Rd, Ste 650, Bethesda, MD, 20814, USA.
| | - Donna McMorrow
- Truven Health Analytics, 7700 Old Georgetown Rd, Ste 650, Bethesda, MD, 20814, USA
| | - Amanda M Farr
- Truven Health Analytics, 7700 Old Georgetown Rd, Ste 650, Bethesda, MD, 20814, USA
| | - Paul Juneau
- Truven Health Analytics, 7700 Old Georgetown Rd, Ste 650, Bethesda, MD, 20814, USA
| | - Sarika Ogale
- Genentech, Inc, 1 DNA Way, South San Francisco, CA, 94080, USA
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15
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Fragoulakis V, Vitsou E, Hernandez AC, Maniadakis N. Economic evaluation of anti-TNF agents for patients with rheumatoid arthritis in Greece. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:85-93. [PMID: 25653545 PMCID: PMC4303331 DOI: 10.2147/ceor.s75323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives We aimed to estimate the total mean annual treatment cost of different therapy options for patients with moderate-to-severe rheumatoid arthritis (RA) in Greece. Methods A cost-minimization approach was adopted. An economic model was developed to estimate the direct costs of the three widely used treatments within a 1-year time horizon, from a health care payer perspective, either for new or for existing patients. Data on resource use, dose escalation, and frequency of therapy were based on a nationwide field survey of rheumatologists. Other analyses were also undertaken based on evidence from the literature. Total cost comprised the cost of drugs, administration, and hospital day care visits. Unit cost data were obtained from the price bulletin and the government gazettes issued by the Ministry of Health. Due to the short time horizon of the study, the cost was not discounted. Results The mean annual total cost per new (or per existing) responder patient on etanercept was estimated at €9,845 (€9,840), and the total cost on etanercept/methotrexate (MTX) was estimated at €9,857 (€9,852). Therapy with etanercept had lower annual cost relative to adalimumab and infliximab. On an annual basis, it was estimated that the difference between etanercept monotherapy and adalimumab monotherapy was €544 (€1,323). Similarly, the difference between etanercept/MTX and infliximab/MTX was €1,871 (€1,490) and €543 (€1,323), respectively, relative to adalimumab/MTX. Results remained constant under other scenario analyses undertaken. Conclusion In the real-life practice setting in Greece, where dose intensity and frequency differences occur, etanercept alone or in combination with MTX, if prescribed as per label, represents the option with lower annual cost per patient when compared with adalimumab or infliximab in patients with RA. These results hold true as long as the assumptions and data used in the analysis remain stable and may alter if any of the underlying parameters, such as drug price, change.
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Borrás-Blasco J, Navarro Ruiz A. Dose modification of anti-TNF in rheumatoid arthritis and estimated economical impact: a review of observational studies. Expert Rev Pharmacoecon Outcomes Res 2015; 15:71-9. [PMID: 25555555 DOI: 10.1586/14737167.2015.967219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anti-TNF drugs indicated for the treatment of moderate-to-severe active rheumatoid arthritis (RA) presents similar efficacy, safety and potential toxicity profiles, with more than 10 years' treatment experience. Several pharmacoeconomic evaluations had demonstrated their favorable cost-effectiveness profile in RA patients, based on pivotal clinical studies data from different countries and perspectives. However, in clinical practice, individual profiles of patients and drugs leads to dose modifications that may be associated with substantial cost deviations. Here, we further discuss the effect of dose titration of these biological drugs in clinical practice over their RA cost-effectiveness profiles.
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Affiliation(s)
- Joaquín Borrás-Blasco
- Specialist in Hospital Pharmacy, Pharmacy Service, Pharmacy Department, Hospital de Sagunto, Avda Ramon y Cajal s/n Sagunto E-46520 Valencia, Spain
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Bonafede M, Joseph GJ, Shah N, Princic N, Harrison DJ. Cost of tumor necrosis factor blockers per patient with rheumatoid arthritis in a multistate Medicaid population. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:381-8. [PMID: 25246804 PMCID: PMC4168856 DOI: 10.2147/ceor.s61445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to estimate the annual cost per treated patient for the tumor necrosis factor (TNF) blockers, etanercept, adalimumab, and infliximab in rheumatoid arthritis (RA) patients covered by Medicaid. Methods The MarketScan Medicaid Multistate Database was used to identify adult RA patients who used etanercept, adalimumab, or infliximab (index agents) from 2007 to 2011. The index date was the first claim preceded by 180 days and followed by 360 days of continuous enrollment. Patients with other conditions for which these agents are approved by the US Food and Drug Administration were excluded. “Continuing” patients had one or more pre-index claim for their index biologic, and “new” patients did not. Cost per treated patient was calculated in the 360 day post-index period for each index agent as the total index drug and administration cost to the payer and the costs of switched-to agents divided by the number of patients who received the index agent. Results A total of 1,085 patients met the study criteria. Forty-eight percent received etanercept (n=521); 37% received adalimumab (n=405); and 15% received infliximab (n=159). Patient characteristics were similar across groups (mean age 47.4 years, 83% female). The annual cost per treated patient was lowest for etanercept ($18,466), followed by adalimumab ($20,983) and infliximab ($26,516). For all agents, annual costs were lower for new patients ($17,996 for etanercept, $18,992 for adalimumab, and $24,756 for infliximab) than for continuing patients ($19,004 for etanercept, $24,438 for adalimumab, and $28,127 for infliximab). Conclusion Etanercept had lower costs per treated patient than adalimumab or infliximab in both new and continuing Medicaid enrollees with RA.
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Wu N, Lee YCD, Shah N, Harrison DJ. Cost of biologics per treated patient across immune-mediated inflammatory disease indications in a pharmacy benefit management setting: a retrospective cohort study. Clin Ther 2014; 36:1231-41, 1241.e1-3. [PMID: 25062652 DOI: 10.1016/j.clinthera.2014.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/13/2014] [Accepted: 06/09/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Pharmacy benefits management companies have emerged as the national standard for the management of prescription drugs in the United States. The objective of this study was to estimate the annual costs per treated patient of 8 biologics indicated for select immune-mediated inflammatory diseases: moderate to severe rheumatoid arthritis, moderate to severe plaque psoriasis, active psoriatic arthritis, and/or active ankylosing spondylitis. METHODS Using the Medco pharmacy benefits-management database, data from patients aged 18 to 63 years with ≥1 claim for abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, or ustekinumab, dated between January 1, 2008 and August 31, 2011, were collected. Eligible patients were continuously enrolled for ≥180 days before and 360 days after the date of the first biologic claim (index date), and had ≥1 claim associated with a diagnosis of rheumatoid arthritis, moderate to severe plaque psoriasis, active psoriatic arthritis, and/or active ankylosing spondylitis in the 180 days before or 30 days after the index date. The annual total costs per treated patient were calculated as the total dose of the index biologic and all other biologics for which there was a claim in the postindex period, multiplied by the wholesale acquisition cost as of October 1, 2013, plus the costs associated with administrations (calculated as number of infusions multiplied by the 2013 Medicare Physician Fee Schedule costs). FINDINGS Within the study population (N = 8306; 5356 (64.5%) women, 2950 men (35.5%), average age: 42.3 years (SD: 10.0)), the most commonly used biologics were etanercept (43.1%), adalimumab (31.0%), and infliximab (17.0%), which accounted for 91.1% of all biologic prescriptions. Total costs per treated patient across indications were as follows: adalimumab, $23,427 to $26,304; infliximab, $22,824 to $28,907; and etanercept, $21,468 to $27,748, whereas abatacept, certolizumab, golimumab, rituximab, and ustekinumab were associated with a larger range: $17,017 to $41,888. IMPLICATIONS The present study provides insight into the prescribing patterns and cost differences among 8 biologic agents used for the treatment of immune-mediated inflammatory diseases. This information may prove useful when designing a pharmacy benefits-management formulary.
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Affiliation(s)
- Ning Wu
- Evidera, Lexington, Massachusetts.
| | | | - Neel Shah
- Amgen Inc, Thousand Oaks, California
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