Background/Purpose: Of the seven biologics FDA-approved for the treatment of moderate to severe rheumatoid arthritis (RA) as of August 2011, etanercept, adalimumab, certolizumab, and golimumab were subcutaneously (SC) administered; abatacept, infliximab, and rituximab were intravenous (IV) infusions. Utilization of these agents is often controlled by Pharmacy Benefits Managers (PBMs) using various methods which can affect dosing in clinical practice, gaps in therapy, treatment persistence and switching, and in turn the costs.  This study describes the annual cost of biologics per treated patient with RA using administrative claims from a PBM.

Methods: The Medco Database was used to identify adults (18-63 years) with a claim for etanercept, adalimumab, infliximab, abatacept, rituximab, golimumab, or certolizumab between July 1, 2008 and August 31, 2011 preceded by ≥180-days of enrollment. The first claim for biologics was used to define the index agent and date. Patients had to be continuously enrolled for ≥360 days post-index and have a diagnosis of RA between 180 days before and 30 days after the index date. Patients with other conditions for which some of these agents are indicated (e.g. psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, non-Hodgkin’s lymphoma, or chronic lymphocytic lymphoma) were excluded. Annual cost per treated patient equaled total dose for the index biologic and all other biologics taken in the post-index period multiplied by wholesale acquisition cost (WAC) as of June 1, 2013, plus the costs associated with administrations, calculated as number of infusions multiplied by the 2013 Medicare Physician Fee Schedule costs. 

Results:

In the 4,736 patients with RA in this study, etanercept (40.3%), adalimumab (27.9%), and infliximab (19.0%) were the most frequently prescribed biologics followed by abatacept (7.1%), rituximab (3.7%), golimumab (1.2%), and certolizumab (0.7%). Mean age was 51.2 years (SD 9.1) and 78.5% were female. Among the three most commonly prescribed biologics, the annual cost per treated patient was lowest for patients on etanercept ($21,706), followed by infliximab ($22,030) and adalimumab ($23,150). Among the other agents, cost per treated patient was highest for certolizumab ($21,630), followed by golimumab ($20,526), abatacept ($17,386), and rituximab ($16,571).

Conclusion:

Of the three most frequently prescribed biologics for RA, the annual cost per treated patient was the lowest for etanercept.  Cost may be an additional consideration when choosing biologic treatments for RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-consideration-for-biologics-for-patients-with-rheumatoid-arthritis-in-a-pharmacy-benefit-management-setting/