Background/Purpose: Etanercept (ETN), adalimumab (ADA), and infliximab (INF) are FDA-approved tumor necrosis factor (TNF)-blocker treatments for moderate to severe rheumatoid arthritis (RA) and are commonly used first-line biologics. These agents have differing modes of administration and dose ranges. It is important to understand the true cost of treatment with these agents including the effects of real-world dosing data, gaps in therapy, varying persistence, and switching. This study describes the annual TNF-blocker costs for patients treated with ETN, ADA, and INF, using data from a US managed care population.

Methods: The IMS LifeLink™ Health Plan Claims database was used to identify RA patients (18-64 years) with ≥ 1 claim for ETN, ADA, or INF between February 1, 2008 and July 5, 2010. Their first TNF-blocker claim after ≥ 6 months of continuous enrollment defined their index claim and medication. Patients were classified as “new” if they did not have a claim for the same agent in the previous 6 months (pre-index period) or “continuing” if they did. Patients were followed for 1 year after their index claim. Patients were excluded if they had a diagnosis in their pre-index period of psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, or juvenile idiopathic arthritis. Total annual TNF-blocker dose was computed and costs were calculated using the March 2012 wholesale acquisition costs and Medicare Physician Fee Schedule for TNF-blocker related administrations. For patients who switched agents in the first year, costs of other TNF blockers used were attributed to the patients’ index medication.

Results: Overall, 16,280 patients with RA (7,754 [47.6%] ETN, 4,834 [29.7%] ADA, 3,692 [22.7%] INF) were identified. Mean age was 50.3 years and 76.5% were female. Overall, patient characteristics were similar. INF was more commonly given by a rheumatologist (63.3% vs 57.3% ADA and 53.5% ETN) and less likely to be a new agent (28.4% vs 39.1% ADA and 33.7% ETN). The majority of patients had commercial insurance (83.0%-86.0%) and the majority of plans were preferred provider organizations (65.0%-70.0%). The overall 1-year TNF-blocker cost per RA patient was lowest for patients on ETN ($16,787), followed by ADA ($19,308) then INF ($22,939). For patients new to TNF-blockers, 1-year cost per treated patient was $15,828 for ETN, $17,250 for ADA, and $19,397 for INF; 1-year cost per continuing patient was $17,275 for ETN, $20,626 for ADA, and $24,345 for INF.

Conclusion: Across new and continuing RA patients, ETN was the most frequently prescribed TNF-blocker and had the lowest cost per treated patient as observed in real-world drug utilization data.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/costs-of-tumor-necrosis-factor-blockers-per-treated-rheumatoid-arthritis-patient-using-real-world-drug-data-in-a-us-managed-care-population/