Background The number of biologic agents approved for treatment of moderate to severe RA has increased recently. Formulary choice of agents is frequently based on costs. Although many biologic agents approved for RA are also approved for other indications, the majority of use is for RA.
Objectives To estimate annual biologic cost per treated patient in RA using drug utilization and dosing data from US managed care administrative claims and associated standardized costs.
Methods The IMS LifeLink Health Plan Claims Database was used to identify adults with RA (18-63 years) with a claim for etanercept, adalimumab, infliximab, abatacept, rituximab, golimumab, or certolizumab between Jan 1, 2008 and Dec 31, 2010 preceded by ≥180-days of enrollment. The LifeLink Database is comprised of fully adjudicated medical and pharmaceutical claims for over 65M unique patients from 80 health plans across the US and contains approximately 16M covered lives per year. The LifeLink database is generally representative of the national, commercially insured US population. For this study, patients were required to have had a diagnosis of RA between 180 days before and 30 days after index and be enrolled for ≥360 days post-index. The first biologic claim meeting these criteria defined the index date. Patients with a diagnosis of psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, non-Hodgkins lymphoma, or chronic lymphocytic lymphoma were excluded. Both “New” and “Continuing” patients were included. “New” patients did not have a claim for the same biologic in the 6-months pre-index data; “Continuing” did. Annual cost per treated patient equaled total dose for the index biologic and biologics taken after discontinuation of the index biologic multiplied by January 2013 Wholesale Acquisition Cost, plus number of administrations multiplied by 2012 Medicare Physician Fee Schedule values.
Results Of 19,948 included patients, 88% received the TNF blockers etanercept (n=8,363), adalimumab (n=5,348), or infliximab (n=3,888). Most patients (77%) were female, mean age 50.6 years (SD=9.3). Pooled across new and continuing patients, cost per treated patients was $20,957 for etanercept, $21,363 for infliximab, $21,772 for adalimumab, $17,949 for abatacept (n=1,394), $17,423 for rituximab (n=734), $16,341 for golimumab (n=120) and $19,751 for certolizumab (n=101). Cost per treated patient among new patients was $19,815 for etanercept (n=3,300), $19,658 for adalimumab (n=2,420), $18,249 for infliximab (n=1,183). In continuing patients the costs ranged from $21,701 for etanercept (n=5,063), $23,519 for adalimumab (n=2,928) and $22,726 for infliximab (n=2,705).
Conclusions Among biologic agents for RA, the established TNF-blockers accounted for the majority (88%) of use, and of those, etanercept had the highest cost per treated patient for new RA patients, and lowest for continuing and pooled RA patients. Cost per treated patient for adalimumab was higher than infliximab in new and pooled RA patients. Although cost per treated patient was lower with newer agents, the sample size was much lower for these agents and more research is needed to confirm these finding and understand whether there are differences in disease severity in patients using those agents.
Acknowledgements Research funded by Immunex Corporation, a wholly owned subsidiary of Amgen Inc., and by Wyeth, which was acquired by Pfizer Inc. in October 2009.
Disclosure of Interest V. Schabert: None Declared, J. Korn: None Declared, S. P. Bilir: None Declared, M. Dekoven: None Declared, D. Harrison Shareholder of: Amgen Inc., Employee of: Amgen Inc., G. Joseph Shareholder of: Amgen Inc., Pfizer Inc., Employee of: Amgen Inc.