Background/Purpose: Infliximab (IFX) is more frequently selected than golimumab for intravenous use (GLM-IV) in patients with Rheumatoid Arthritis (RA) but differences in dosing and administration recommendations for these products may have budgetary consequences. This study aimed to determine the budgetary impact of IFX and GLM-IV based upon real-world treatment patterns and commercial reimbursement in a matched sample of RA patients.

Methods: Truven Commercial Claims and Encounters and Medicare Supplemental data were used to evaluate maintenance infusion interval, frequency of first or subsequent hour billing code and cost of infusions for adult RA patients starting a new episode of IFX (J1745) or GLM-IV (J1604). Adult patients with ≥12 months continuous enrollment before and after the 1^st IFX or GLM-IV claim (index) between 1/1/2014 and 3/31/2016 and no evidence of index medication use 12 months before index were studied. IFX and GLM-IV patients were matched 1:1 on index medication treatment duration, gender, payer type, prior-biologic use and post-index methotrexate (MTX). The payer paid drug plus administration cost was used applied to population treatment patterns. Descriptive statistics summarized key variables (mean, SD, median, n, %). Chi-squared tests determined differences between categorical variables and t-test was used for continuous variables.

Results: A total of 1,094 matched patients were identified (n=547 GLM-IV; n=547 IFX). In both groups, median age was 56 years; 82% were female and 38% had no prior biologic use. Mean (SD) follow-up was 609 (161) days (d) for GLM-IV and 613 (163) days for IFX. Mean (SD) duration of GLM-IV use was 396 (240) d and 397 (239) d for IFX. A total of 3,961 GLM-IV infusions and 4,716 IFX infusions were administered. The proportion of maintenance infusions given every 8 wk was 80% for GLM-IV vs 39% for IFX; 6% of GLM-IV vs 53% of IFX infusions occurred more frequently than every 8 wk (P<0.0001). Mean drug plus administration cost per infusion was $5,846.10 (GLM-IV) and $5,443.66(IFX). Mean GLM-IV administration cost was $224.26 with <1% of infusions having a second hour billing code vs IFX with mean administration cost of $360.36 and 96% of IFX infusions requiring a second hour billing code (P<0.0001). Based upon the average maintenance infusion interval, GLM-IV patients cost approximately $10,507 less than IFX patients in the first year and approximately $6,774 less than IFX patients in subsequent years.

Conclusion: From the commercial health plan perspective, annual GLM-IV drug plus administration cost was less than IFX in RA patients due to differences in real-world dosing and administration. These findings have important implications for population health decision makers.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/budgetary-impact-analysis-of-real-world-dosing-patterns-in-matched-cohorts-of-rheumatoid-arthritis-patients-treated-with-infliximab-or-golimumab-intravenous-anti-tnf-medications/