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Fiehn C, Zinke S, Haas JS, Meise D, Theil J, Gurrath M, Orzechowski HD. Real-world treatment persistence in patients with rheumatoid arthritis initiating DMARDs in Germany-a health insurance claims data analysis. Z Rheumatol 2023; 82:739-753. [PMID: 36757417 PMCID: PMC10627963 DOI: 10.1007/s00393-023-01323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To investigate treatment patterns in patients with rheumatoid arthritis (RA) in Germany who had previously received conventional synthetic (cs) or biologic (b) disease-modifying antirheumatic drugs (DMARDs). METHODS Patients with RA who initiated treatment with a csDMARD, bDMARD, or Janus kinase (JAK) inhibitor between 2017 and 2018 and who had previously received csDMARD or bDMARD therapy were retrospectively selected from the Institute for Applied Health Research Berlin GmbH (InGef). Time on treatment and discontinuation risk were assessed using the Kaplan-Meier method. Cox regression identified variables associated with an increased discontinuation risk. RESULTS A total of 990 patients had received prior csDMARD therapy; 375 had received prior bDMARD therapy. Tumor necrosis factor (TNF)-α inhibitors and JAK inhibitors were the most commonly prescribed DMARD class in those previously treated with a csDMARD or bDMARD, respectively. In both cohorts, more patients received DMARD monotherapy than combination therapy. In the prior csDMARD cohort, median time on treatment was 276, 252, and 148 days with JAK inhibitors, TNF‑α inhibitors, and csDMARDs, respectively, and those treated with JAK or TNF‑α inhibitors were less likely to discontinue treatment than those on csDMARDs (log-rank test p-value < 0.01 for both comparisons); no significant differences were found within the prior bDMARD cohort. CONCLUSION This is among the first detailed analyses of RA treatment patterns in a real-world setting in Germany since the introduction of JAK inhibitors. TNF‑α inhibitors were the most commonly prescribed DMARD after failure of an initial csDMARD, while JAK inhibitors were the most common among patients previously treated with a bDMARD. In both groups, monotherapy with bDMARD or targeted synthetic DMARD was common. In the prior csDMARD cohort, treatment duration was significantly longer with JAK or TNF‑α inhibitors than with csDMARDs.
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Affiliation(s)
- Christoph Fiehn
- Rheumatology and Clinical Immunology Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Germany.
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Link H, Thompson SF, Tian M, Haas JS, Meise D, Maas C, Dimitrov S. A comparative assessment of neutropenia events, healthcare resource use, and costs among cancer patients treated with lipegfilgrastim compared with pegfilgrastim in Germany. Support Care Cancer 2022; 30:9317-9327. [PMID: 36076105 DOI: 10.1007/s00520-022-07353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We assessed the occurrence of neutropenia and febrile neutropenia (FN) and the associated healthcare resource in cancer patients receiving myelosuppressive chemotherapy in combination with pegfilgrastim versus lipegfilgrastim. METHODS This is a retrospective analysis using a German health insurance claims database. Adults receiving chemotherapy with a prescription code for pegfilgrastim (n = 734) or lipegfilgrastim (n = 346) were observed over a 1-year follow-up period. Patient subgroups were analyzed according to cancer type and FN risk. FN risk was based on the chemotherapy regimen and any additional neutropenia risk factors. Outcomes were adjusted via regression analysis. RESULTS Most patients were classified as high FN risk (70.0% pegfilgrastim; 65.6% lipegfilgrastim cohort). The mean age was 58.2 years in the pegfilgrastim cohort and 58.0 years in the lipegfilgrastim cohort, with more female patients than male patients (77.3% vs 79.8%, respectively), and the majority had breast cancer (64.9% and 68.8%, respectively). Overall, 10.0% and 10.4% of patients receiving pegfilgrastim or lipegfilgrastim experienced a neutropenia event (p = 0.82), with 4.4% and 3.5% of patients experiencing a FN event (p = 0.49). The mean neutropenia event-related healthcare costs were €604 and €441 for the pegfilgrastim and lipegfilgrastim cohorts; among patients with lymphoma, these costs were significantly greater (p = 0.03) with pegfilgrastim (€1,612) versus lipegfilgrastim (€382). The mean all-cause hospitalizations were significantly (p < 0.01) higher for lymphoma patients receiving pegfilgrastim (2.76) versus lipegfilgrastim (1.60). CONCLUSION Overall, patients treated with pegfilgrastim and lipegfilgrastim were comparable in terms of neutropenia occurrences in the 1-year follow-up. In patients with lymphoma, neutropenia event-related healthcare costs and all-cause hospitalizations were significantly higher with pegfilgrastim compared with lipegfilgrastim in this study; however, this should be interpreted with caution in light of the limited sample size and the absence of clinical information.
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Affiliation(s)
- Hartmut Link
- Private Practice Hematology and Oncology, Kaiserslautern, Germany.
| | | | - Marc Tian
- TEVA Pharmaceuticals Industries Ltd., West Chester, PA, USA
| | | | | | | | - Stamen Dimitrov
- TEVA Pharmaceuticals Europe, HQ Amsterdam, Amsterdam, Netherlands
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Link H, Thompson S, Tian M, Meise D, Haas J, Maas C, Dimitrov S. 1706P A comparative assessment of neutropenia events, healthcare resource use, and costs among patients treated with long-acting granulocyte-colony stimulating factor in Germany. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Canbay A, Kachru N, Haas JS, Meise D, Ozbay AB, Sowa JP. Healthcare resource utilization and costs among nonalcoholic fatty liver disease patients in Germany. Ann Transl Med 2021; 9:615. [PMID: 33987313 PMCID: PMC8106103 DOI: 10.21037/atm-20-7179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are associated with progression to advanced liver diseases that include compensated cirrhosis, decompensated cirrhosis, liver transplantation, and hepatocellular carcinoma (HCC). This study characterized comorbidities, healthcare resource utilization (HRU), and associated costs among NAFLD patients in Germany. Methods German healthcare claims data between 2011 and 2016 were analyzed retrospectively. Adult patients diagnosed with NAFLD and/or NASH were categorized as NAFLD, NAFLD non-progressors, compensated cirrhosis, decompensated cirrhosis, liver transplant, or HCC. Within each stage, annual all-cause HRU and costs were measured during the pre- and post-index periods. Results Among 4,580,434 patients in the database, proportion of NAFLD was 4.7% (n=215,655). Of them, 36.8% were non-progressors, 0.2% compensated cirrhosis, 9.6% decompensated cirrhosis, 0.0005% liver transplant, and 0.2% HCC. Comorbidity rates were significantly higher in compensated cirrhosis, decompensated cirrhosis, and HCC compared with non-progressors (52.07%, 56.46%, 57.58% vs. 27.49% for cardiovascular disease; 77.13%, 76.61%, 83.47% vs. 54.89% for hypertension; 47.20%, 53.81%, 52.89% vs. 35.21% for hyperlipidemia; 49.88%, 36.67%, 48.21% vs. 20.38% for type 2 diabetes mellitus). The mean annual numbers of post-index outpatient visits and inpatient hospitalizations were significantly higher in patients with advanced liver diseases versus non-progressors. Mean annual costs were significantly higher among patients with advanced liver diseases (compensated cirrhosis, €10,291; decompensated cirrhosis, €22,561; liver transplant, €34,089; HCC, €35,910) than non-progressors (€3,818, P<0.001, except liver transplant cohort). This trend remained consistent after adjusting for baseline demographics and comorbidities. Conclusions NAFLD patients in Germany are grossly underdiagnosed and exert substantial healthcare resource use and economic burden, particularly those with advanced liver diseases. Optimal strategies for early identification and management are needed to prevent disease progression and limit the rising costs.
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Affiliation(s)
- Ali Canbay
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Nandita Kachru
- Gilead Sciences, Inc., Health Economics Outcomes Research, Foster City, CA, USA
| | | | | | - A Burak Ozbay
- Gilead Sciences, Inc., Health Economics Outcomes Research, Foster City, CA, USA
| | - Jan-Peter Sowa
- Department of Internal Medicine, Ruhr-University Bochum, Bochum, Germany
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Sewerin P, Borchert K, Meise D, Schneider M, Mahlich J. Health resource utilization and associated healthcare costs of biologic disease modifying antirheumatic drugs in German patients with psoriatic arthritis. Arthritis Care Res (Hoboken) 2021; 74:1435-1443. [PMID: 33742791 DOI: 10.1002/acr.24598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate healthcare costs associated with biologic disease-modifying antirheumatic drugs (bDMARDs) in a German real-world cohort of adult biologic-naïve patients with psoriatic arthritis (PsA). METHODS Claims data from the InGef research database for patients with a PsA diagnosis and bDMARD claims record (index date) between January 1st , 2014 and December 31st , 2017; and no bDMARD prescription for 365 days before the index date, were retrospectively analyzed. Primary outcomes were determination of healthcare resource utilization (HRU) and associated annual healthcare costs for overall and individual bDMARDs in the 12-month pre- and post-index periods. These outcomes were compared between persistent and non-persistent groups. Non-persistence was defined as treatment gap or switch to bDMARD other than the index therapy. RESULTS Among 10,954 patients with a PsA diagnosis, 348 were eligible. Although mean (SD) post-index costs were significantly higher in the persistent group than the non-persistent group (€27,869 [8,001] vs. €21,897 [10,600]; P<0.001) due to higher bDMARD acquisition costs (€23,996 [4,818] vs. €16,427 [9,033]; P<0.001), persistence reduced inpatient treatment costs (-€760), outpatient treatment costs (-€192), other drug costs (-€724), and sick leave costs (-€601). CONCLUSION Although initiation of bDMARDs increased the total healthcare costs irrespective of persistence status, partial cost offsets were observed in the persistent patient population.
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Affiliation(s)
- Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | | | | | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Mahlich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany.,Düsseldorf Institute of Competition Economics (DICE), University of Düsseldorf, Germany
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Sewerin P, Borchert K, Meise D, Schneider M, Mahlich J. Real-World Treatment Persistence with Biologic Disease-Modifying Antirheumatic Drugs Among German Patients with Psoriatic Arthritis-A Retrospective Database Study. Rheumatol Ther 2021; 8:483-497. [PMID: 33611778 PMCID: PMC7991063 DOI: 10.1007/s40744-021-00286-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To investigate drug survival for biologic disease-modifying antirheumatic drugs (bDMARDs) in a real-world cohort of German adult biologic-naïve patients with psoriatic arthritis (PsA). METHODS Claims data for patients with a diagnosis of PsA, a bDMARD claims record (index date) between 1 January 2014 and 31 December 2017, and no bDMARD prescription for 365 days before the index date were retrospectively analyzed. The primary outcomes were the overall and individual bDMARD persistence rates over 12 months. Nonpersistence was defined as a treatment gap exceeding the days of supply plus 60 days or switching to a bDMARD other than the index therapy. Sensitivity analysis was performed, wherein the treatment gap was found to vary depending on the bDMARD regimen. Kaplan-Meier curves were plotted to determine persistence; the log-rank test was used to evaluate differences in the persistence rate. Factors associated with treatment discontinuation were evaluated using Cox regression analysis. RESULTS Among 10,954 patients with a PsA diagnosis, 348 were eligible. The overall bDMARD persistence rate was 57.5%; individual bDMARD persistence rates were 81.3% for ustekinumab, 66.7% for infliximab, and 60.0% for golimumab. The mean (SD) overall persistence with bDMARDs was 289 (103) days; the mean persistence was 334 (72) days for ustekinumab, 309 (82) days for golimumab, and 305 (92) days for infliximab. The main reasons for nonpersistence were switching to another bDMARD (15.8%) and treatment discontinuation (26.7%). Male gender was significantly associated with a lower risk of treatment discontinuation (hazard ratio 0.54, 95% confidence interval 0.39-0.77; P < 0.001). The sensitivity analysis yielded similar results. CONCLUSION The one-year persistence rate for bDMARDs in German PsA patients is modest, although the persistence rate depends on the bDMARD considered.
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Affiliation(s)
- Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany.
| | | | | | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Mahlich
- Health Economics and Outcomes Research, Janssen, Pharmaceutical Companies of Johnson & Johnson, Neuss, Germany
- Düsseldorf Institute of Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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Canbay A, Kachru N, Haas JS, Sowa JP, Meise D, Ozbay AB. Patterns and predictors of mortality and disease progression among patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2020; 52:1185-1194. [PMID: 33016540 DOI: 10.1111/apt.16016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/05/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Factors associated with mortality and disease progression in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are poorly understood. AIMS To assess the impact of liver disease severity, demographics and comorbidities on all-cause mortality and liver disease progression in a large, real-world cohort of NAFLD patients. METHODS Claims data from the German Institut für angewandte Gesundheitsforschung database between 2011 and 2016 were analyzed retrospectively. Adult patients diagnosed with NAFLD and/or NASH were categorised as NAFLD, NAFLD non-progressors, compensated cirrhosis, decompensated cirrhosis, liver transplant or hepatocellular carcinoma (HCC). The longitudinal probability of mortality and incidence of progression were calculated for disease severity cohorts and multivariable analyses performed for adjusted mortality. RESULTS Among 4 580 434 patients in the database, prevalence of NAFLD was 4.7% (n = 215 655). Of those, 36.8% were non-progressors, 0.2% compensated cirrhosis, 9.6% decompensated cirrhosis, 0.0005% liver transplant and 0.2% HCC. Comorbidity rates were significantly higher in compensated cirrhosis, decompensated cirrhosis and HCC compared with non-progressors. The longitudinal probability of mortality for non-progressors, compensated cirrhosis, decompensated cirrhosis and HCC was 3.6%, 18.7%, 28.8% and 68%, respectively. Independent predictors of mortality included cardiovascular disease, type 2 diabetes mellitus, hypertension, obesity and renal impairment. The cumulative incidence of progression in NAFLD and compensated cirrhosis patients was 10.7% and 16.7%, respectively, over 5 years of follow-up. CONCLUSION NAFLD patients were severely under-diagnosed and had a high probability of mortality that increased with disease progression. Early identification and effective management to halt or reverse fibrosis are essential to prevent progression.
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Affiliation(s)
- Ali Canbay
- Department of Internal Medicine, Ruhr-University, Bochum, Germany
| | - Nandita Kachru
- Health Economics Outcomes Research, Gilead Sciences Inc., Foster City, CA, USA
| | | | - Jan-Peter Sowa
- Department of Internal Medicine, Ruhr-University, Bochum, Germany
| | | | - Ahmet Burak Ozbay
- Health Economics Outcomes Research, Gilead Sciences Inc., Foster City, CA, USA
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Sewerin P, Borchert K, Meise D, Mahlich J. SAT0438 REAL-WORLD TREATMENT PERSISTENCE WITH BIOLOGIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS AMONG GERMAN PATIENTS WITH PSORIATIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Persistence rates of biologic disease modifying antirheumatic drugs (bDMARDs), which refer to the duration of time from initiation to discontinuation or switch of therapy, have been shown to vary considerably depending on the country, types of health centers, as well as the specific drug being investigated. Evidence on treatment persistence of psoriatic arthritis (PsA) patients in Germany is scarce.Objectives:Our aim was to study drug survival of bDMARDs in a German real-world cohort of adult biologic-naïve psoriatic arthritis patients.Methods:We utilized the German “Institut für angewandte Gesundheitsforschung Berlin” (InGef) research database consisting of about 4 million covered lives structured to represent the German population in terms of age and gender according to the Federal Office of Statistics (DESTATIS). Thereof, 2.9 million patients were continuously enrolled in the study period spanning from January 1st, 2013 and December 31st, 2018. For the analysis of persistence rates, the study population was identified based on the International Classification of Diseases, German Modification (ICD-10-GM) and claims records of biologic prescriptions based on ATC codes. Adult patients who had a diagnosis of psoriasis arthritis (L40.5 in combination with M07.0 or M07.1 or M07.2 or M07.3) in the inpatient or outpatient setting, and a claims record of biologic treatment licensed for psoriasis arthritis between January 1st, 2014 to December 31st, 2017 were included. Patients with Crohn’s disease (K50), ulcerative colitis (K51), ankylosing spondylitis (M45), and rheumatoid arthritis (M05-M07) were excluded. Biologic-naïve patients were identified as those who had no prior record of bDMARDs prescription during the 12 months before the index date (‘washout’). The index date was defined as the first claim for a biologic agent. Non-persistence occurred if a treatment gap exceeding the days of supply plus 60 days or a switch to a bDMARD other than the index therapy was observed. Days of supply were calculated based on the daily defined doses defined by the WHO for the respective bDMARDs. Kaplan-Meier curves were plotted to show the persistence of different biologics. The log-rank test was used to test for differences in the 1-year persistence rate.Results:Among 10,954 patients with a diagnosis of PsA, 348 biologic-naïve patients aged 18 years or above were identified. The one-year overall persistence rate was 57.5% for all bDMARD compounds. Reasons for non-persistence were switches to a different bDMARD agent in 15.8% of patients and 26.7% discontinued treatment. The highest persistence rate was observed for ustekinumab (81.3%), which was significantly higher than the respective rates for adalimumab (58.1%), certolizumab pegol (51.7%), etanercept (51.0%), or secukinumab (54.7%).Conclusion:Persistent rates for a real-world cohort of German PsA patients are modest with significant variations among different bDMARD therapies.Disclosure of Interests:Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KGBristol-Myers Squibb Celgene GmbHLilly Deutschland GmbHNovartis Pharma GmbH Pfizer Deutschland GmbHRheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Kathrin Borchert Consultant of: Janssen-Cilag GmbH, Dominic Meise Consultant of: Janssen-Cilag GmbH, Jörg Mahlich Shareholder of: Janssen-Cilag GmbH, Employee of: Janssen-Cilag GmbH
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Haas J, Braunhofer P, Zakin L, Rakov V, Hardt T, Meise D, Maas C, Braun S. MP397HYPERKALEMIA INCIDENCE AND PATTERNS OF CARE IN PATIENTS TREATED WITH RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS - A RETROSPECTIVE CLAIMS DATA ANALYSIS TO ASSESS HEALTHCARE OUTCOMES IN GERMANY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx170.mp397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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