Real-world changes in costs over time among patients in the United States with hereditary angioedema on long-term prophylaxis with lanadelumab

Abstract

Aims

Investigate trends in paid lanadelumab costs over time in a population of patients persistent for 18 months, and to understand overall hereditary angioedema (HAE) treatment cost trends, including costs of acute medication/short-term prophylaxis and supportive care. Lastly, we sought to describe the proportion of lanadelumab patients with evidence of down titration via changes in total paid amounts for lanadelumab in a fixed time period.

Methods

Patients were identified in the Merative MarketScan Databases who had ≥1 claim for lanadelumab during 1/1/2018-6/30/2022 (index), a ≤ 60-d gap in days of supply over 18 months, and were enrolled for ≥6 months pre-index and 18 months post-index. Lanadelumab and HAE-specific costs were assessed during follow-up months 0–6, 7–12, and 13–18. Down titration was defined as a ≥ 25% decrease in lanadelumab costs from months 0–6 to months 7–12 or 13–18. Outcomes were compared between time periods using paired t-tests and McNemar’s test.

Results

Fifty-four lanadelumab users were included; 25 (46%) had evidence of down titration. Lanadelumab costs decreased from $316,724 to $269,861 to $246,919 in months 0–6, 7–12, and 13–18, respectively (p < .01); total HAE treatment costs decreased from $377,076 to $329,855 to $286,074 in months 0–6, 7–12, and 13–18, respectively (p < .01).

Limitations

Persistence was determined via days of supply on medication claims; use of the medication was not confirmed. Down titration was based on costs; the lanadelumab regimen could not be assessed. Results may not be generalizable to uninsured patients or those without commercial or Medicare insurance.

Conclusions

Patients on long-term prophylaxis with lanadelumab experienced a significant reduction (24%) in HAE treatment costs over 18 months, driven by lower costs of acute medications and lanadelumab down titration. Down titration among appropriate patients with controlled HAE may lead to substantial savings in healthcare costs.

Keywords:

• Hereditary angioedema
• HAE
• persistence
• down titration
• healthcare costs
• healthcare utilization

JEL codes:

• I11
• I1
• I
• I19

Transparency

Declaration of funding

This study was funded by Takeda Pharmaceuticals USA, Inc.

Declaration of financial/other interests

CHS is completing a fellowship sponsored by Takeda. BGS is employed by Takeda. NP and KAE are employed by Merative which received funding from Takeda to conduct this study.

Author contributions

All authors contributed to the design and execution of the study and the writing of the manuscript.

Acknowledgements

Programming services were provided by Caroline Henriques of Merative. These services were paid for by Takeda Pharmaceuticals USA, Inc.

Data availability statement

Merative MarketScan Research Databases are available to purchase by Federal, non-profit, academic, pharmaceutical, and other researchers. The use of the data is contingent on completing a data use agreement and purchasing the data needed to support the study. More information about licensing the Merative MarketScan Research Databases is available at https://www.merative.com/real-world-evidence.

Ethics approval and informed consent

All database records are statistically de-identified and certified to be fully compliant with US patient confidentiality requirements set forth in the Health Insurance Portability and Accountability Act of 1996. Because this study used only de-identified patient records and did not involve the collection, use, or transmittal of individually identifiable data, this study was exempted from Institutional Review Board approval.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

This research was presented in part at the 2023 AMCP annual meeting in San Antonio, TX, USA.

Notes

i MarketScan is a registered trademark of Merative