Background/Purpose: Previous work compared one-year cost per effectively treated patient with biologics for rheumatoid arthritis (RA) using a published, claims-based algorithm.¹ Longer term comparisons are important since RA requires lifetime treatment. Using the same algorithm, treatment effectiveness (as a proxy for low disease activity or remission) and cost per effectively treated patient in the second year of biologic treatment for patients who met effectiveness criteria at the end of the first year was estimated. 

Methods:

Data were obtained from the IMS PharMetrics Plus™ database, comprising adjudicated medical and pharmaceutical claims for 150 million enrollees (40 million annually). The first-year cohort included patients with RA aged 18-63, initiating biologic treatment with etanercept, adalimumab, infliximab, or abatacept between Jan 1, 2007 and Dec 31, 2010, without diagnoses for other approved indications for these biologics or any biologic use for RA in the 6 months before initiation. Patients had to be continuously enrolled for 6 months before and 12 months after initiation; the subset of patients whose initial biologic was classified as “effective” by the algorithm and who were enrolled for a second year were included in this analysis. The algorithm defined lack of effectiveness as: medication possession ratio (MPR) <80% (or fewer infusions than specified on US label), increase in biologic dose or frequency, switching biologics, adding new non-biologic Disease Modifying Anti-Rheumatic Drugs, initiation or increase of glucocorticoid dose, or >1 parenteral or intra-articular injection. Cost was based on patient and health plan paid amounts for biologic drugs and drug administration from the claims.

Results:

Of 16,011 patients in the initial cohort, 1,999 met eligibility criteria for the second-year effectiveness analysis: etanercept (n=994), adalimumab (n=620), infliximab (n=229), and abatacept (n=156). Mean age was 50.8 (SD 8.9), 71.8% were female. In the second year, , 44.9% of abatacept,  47.4% of adalimumab, 47.2% of etanercept, and 45.4% of infliximab patients met criteria for effectiveness. Second-year cost per effectively treated patient as defined in the algorithm was $48,176 for abatacept, $37,082 for adalimumab, $37,306 for etanercept, and $36,954 for infliximab. From the prior study, comparable results were (31.0% and $50,141 etanercept, 28.6% and $56,941 adalimumab, 20.2% and $114,089 infliximab, 28.6% and $73,516 abatacept)¹.

Conclusion: Despite similar effectiveness in the second year, cost per effectively treated patient was lower for TNF blockers (etanercept, adalimumab, and infliximab) than for abatacept.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-effectiveness-and-cost-per-effectively-treated-patient-with-biologics-used-in-rheumatoid-arthritis/