Use of a validated algorithm to estimate the annual cost of effective biologic treatment for rheumatoid arthritis

Abstract

Objectives:

To estimate biologic cost per effectively treated patient with rheumatoid arthritis (RA) using a claims-based algorithm for effectiveness.

Methods:

Patients with RA aged 18–63 years in the IMS PharMetrics Plus database were categorized as effectively treated if they met all six criteria: (1) a medication possession ratio ≥80% (subcutaneous) or at least as many infusions as specified in US labeling (intravenous); (2) no biologic dose increase; (3) no biologic switch; (4) no new non-biologic disease-modifying anti-rheumatic drug; (5) no new or increased oral glucocorticoid; and (6) ≤1 glucocorticoid injection. Biologic cost per effectively treated patient was defined as total cost of the index biologic (drug plus intravenous administration) divided by the number of patients categorized by the algorithm as effectively treated. Similar methods were used for the index biologic in the second year and for a second biologic after a switch.

Results:

Rates that the index biologic was categorized as effective in the first year were 31.0% etanercept (2243/7247), 28.6% adalimumab (1426/4991), 28.6% abatacept (332/1160), 27.2% golimumab (71/261), and 20.2% infliximab (474/2352). Mean biologic cost per effectively treated patient, per the algorithm, was $50,141 etanercept, $53,386 golimumab, $56,942 adalimumab, $73,516 abatacept, and $114,089 infliximab. Biologic cost per effectively treated patient, using this algorithm, was lower for patients who continued the index biologic in the second year and higher after switching.

Conclusions:

When a claims-based algorithm was applied to a large commercial claims database, etanercept was categorized as the most effective and had the lowest estimated 1-year biologic cost per effectively treated patient. This proxy for effectiveness from claims databases was validated against a clinical effectiveness scale, but analyses of the second year or the year after a biologic switch were not included in the validation. Costs of other medications were not included in cost calculations.

Keywords::

• Rheumatoid arthritis
• Biologics
• Effectiveness
• Cost
• Algorithm
• Claims

Transparency

Declaration of funding

This work was funded by Immunex Corporation, a wholly owned subsidiary of Amgen Inc., and by Wyeth, which was acquired by Pfizer Inc. in October 2009.

Declaration of financial/other relationships

Amgen Inc. participated in study design and data analysis, and assisted in preparation of the manuscript. J. Curtis has received consulting fees or honoraria from Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, Bristol-Myers Squibb, Crescendo, and AbbVie. V. Schabert, J. Yeaw, and J. Korn are employees of IMS Health, which received consulting fees for conducting the study from Amgen Inc. C. Quach was a graduate intern of Amgen Inc. at the time of this report. H. Yun has no conflicts of interest to disclose. D. Harrison and D. Collier are employees and stockholders of Amgen Inc. G. Joseph is an employee and stockholder of Sanofi, and a former employee and stockholder of Amgen Inc. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing support was provided by Jonathan Latham (PharmaScribe, LLC, on behalf of Amgen Inc.) and Edward Mancini (Amgen Inc.). Portions of this work were presented at the 2013 Annual Meeting of the International Society for Pharmacoeconomics and Outcomes Research and at the 2013 Annual Meeting of the American College of Rheumatology.