Background/Purpose: Understanding the relative cost of tumor necrosis factor inhibitors (TNFi) can improve resource allocation from a payer’s perspective. Limited data exists in the VA System on the cost per treated patient across the commonly used TNFi therapies for chronic inflammatory arthritides (CIA). To determine the annual drug and administration cost to the US Department of Veterans Affairs (VA) for etanercept (ETN), adalimumab (ADA), and infliximab (INF) per treated patient targeting rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS).

Methods: The Veterans Health Administration (VHA) databases were used to identify adult patients with ≥1 claim for ETN, ADA, or INF between Jan 1, 2008 and Dec 31, 2011. The patient’s first claim for ETN, ADA, or INF ≥1 year following VA enrollment was the index claim and defined the index drug. Patients were required to have a diagnosis of RA (ICD-9-CM 714.0x), PsA (696.0x), or AS (720.0x) and excluded if they had multiple CIAs codes or other conditions (psoriasis, Crohn’s disease, ulcerative colitis, juvenile idiopathic arthritis, non-Hodgkin’s lymphoma, or chronic lymphocytic leukemia) treated with these agents during the one year prior to and the 30 days following index. Veterans without claims or ≥1 claim(s) for the index drug during the 180 days pre-index period were classified as initiating or continuing patients, respectively. One-year cost of biologics was calculated based on Federal Supply Schedule (ADA) or Big Four (ETN, INF) pricing as of November 2014. Administration costs were based on VA-specific fixed costs per infusion ($169.09) and dispensing costs for subcutaneously administered ($25) biologics. 

Results: A total of 10,065 patients with RA (mean age 61.4, ETN: n=5,149; ADA: n=4,155; INF: n=761), 871 patients with PsA (mean age 56.5, ETN: n=490; ADA: n=334; INF: n=47), and 1,511 patients with AS (mean age 51.8, ETN: n=732; ADA: n=675; INF: n=104) were included in the study. The VA incurred greater cost per treated patient for INF users compared with ADA and ETN users across CIAs. Specifically, the one-year cost per treated patient was$15,056, $16,617, and $16,827 for ETN, ADA, and INF in RA; $15,035, $16,016, and $20,465 for ETN, ADA, and INF in PsA; and $14,239, $14,832, and $18,536 for ETN, ADA, and INF in AS. ETN had lower one-year cost per treated patient compared with both ADA and INF across indications in both the cohort of patients initiating and continuing therapy.

Conclusion: Compared with ETN and ADA, INF had higher annual drug and administration cost per treated patient across the investigated CIAs to the US Department of VA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/one-year-cost-of-etanercept-adalimumab-and-infliximab-per-treated-patient-with-chronic-inflammatory-arthritides-in-us-veterans/