Background/Purpose: Tumor Necrosis Factor Inhibitors (TNFi) are the mainstay of treatment for rheumatoid arthritis (RA) in patients with moderate to severe disease. The three most commonly used agents, etanercept (ETN), adalimumab (ADA), and infliximab (INF), differ with respect to frequency of administration, dosing and the approved dose ranges.  In addition, INF is administered as infusion by a healthcare professional, whereas ETN and ADA are self-administered subcutaneously. The goal of this study was to determine the annual TNFi drug and administration costs for RA patients on ETN, ADA, or INF.

Methods: The MarketScan Commercial Database was used to identify adult patients (18-64 years) with ≥1 claim for ETN, ADA, or INF between February 1, 2008 and July 5, 2010.  Patients were required to have a diagnosis of RA and excluded if they had diagnoses for other conditions treated with TNFi (psoriatic arthritis, psoriasis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, or juvenile idiopathic arthritis) in the six months prior to the start of their index TNFi.  The patient’s first TNFi claim after 6-months of continuous enrollment was their index claim and defined their index TNFi. If they had at least one claim for the same agent in the 6-months pre-index they were defined as “continuing”, otherwise they were “new”.  Patients were followed for 1 year and the cost of all TNFi used in that year were attributed to their index TNFi.  Cost of TNFi was calculated based on total dose and the March 2012 wholesale acquisition costs and the Medicare Physician Fee Schedule was used to determine TNFi drug administration costs.

Results: There were 7,003 patients who met the inclusion and exclusion criteria.  ETN was the most frequently used index TNFi agent (3,159) followed by ADA, 2,057 and INF 1,787.  The mean age was similar across agents, (51.1 ETN and ADA and 52.0 INF).  The majority of patients (77.8%) were female and 76.2% of the patients were continuing on therapy. Preferred provider organizations were the most common insurance type, 58.8%-63.2%. Across new and continuing patients combined, the annual TNFi cost per patient was highest for INF ($27,366), followed by $20,594 for ADA and $17,753 for ETN. The costs among continuing patients were higher than the new patients but the trends were similar across both groups. 

Conclusion: TNFi costs differ meaningfully by index TNFi agent in the patients with employer provided health insurance. ADA cost 16% more than ETN and INF cost 54% more than ETN across new and continuing patients combined.  The difference was greater in continuing compared to new patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-of-etanercept-adalimumab-and-infliximab-in-patients-with-rheumatoid-arthritis-with-employer-provided-health-insurance/