Biologic Cost per Effectively Treated Rheumatoid Arthritis Patient in a Large Managed Care Population: A...

Area of Science:

• Pharmacoeconomics
• Comparative Effectiveness Research
• Rheumatology

Background:

• Administrative claims databases previously lacked clinical outcomes, limiting their use in rheumatoid arthritis (RA) comparative effectiveness research.
• A validated claims-based algorithm now enables estimation of biologic effectiveness and cost within the same database.

Purpose of the Study:

• To implement a validated claims-based algorithm to calculate the 1-year biologic cost per effectively treated patient for first-line biologics in moderate-to-severe RA.
• To compare the cost-effectiveness of abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab.

Main Methods:

• Retrospective cohort study using the HealthCore Integrated Research Database (HIRDSM) from July 2009 to January 2013.
• Defined index event as the first biologic claim for RA patients aged 18-63 with prior RA diagnosis.
• Effectiveness algorithm assessed adherence, dose stability, lack of new treatments, and limited glucocorticoid use over 12 months post-index.

Main Results:

• The study included 4844 patients, with an average first-year biologic cost ranging from $14,795 (golimumab) to $19,520 (abatacept).
• Etanercept demonstrated the lowest average first-year biologic cost per effectively treated patient ($50,217).
• Significantly lower costs per effectively treated patient were observed for etanercept compared to golimumab, adalimumab, abatacept, certolizumab pegol, and infliximab (p<0.001).

Conclusions:

• Etanercept exhibited the lowest 1-year biologic cost per effectively treated patient among the evaluated first-line biologics for RA.
• The validated claims-based algorithm provides a feasible method for assessing biologic cost-effectiveness in large managed care populations.