Background/Purpose: High drug costs and lack of transparency of these costs is a major concern in the United States. Biologic therapy for rheumatoid arthritis (RA) is expensive, ranging from $7,000 to $203,000 per patient annually. At our institution, the Department of Defense (DoD) negotiated cost for biologic therapies is not readily available to prescribing physicians. Additionally, there is little guidance on the next best therapy in RA treatment if oral DMARD therapy and an initial TNF inhibitor fails. As a Quality Improvement initiative, we investigated the DoD costs of available biologic treatments for RA. We hypothesized that there would be a change in prescribing patterns and substantial cost reductions if rheumatologists had readily available information on biologic medication prices.

Methods: During phase I of this QI project, we conducted a chart review of RA patients on biologics between January 2015 and December 2016. We documented which biologics were used, assigned a monetary cost for each patient, and assessed the overall impact on cost for each biologic therapy switch. Phase II of the project started with a ‘cost awareness curriculum.’ We acquired and distributed the biologic price-list to Rheumatology clinic personnel. We reviewed the prices and phase I results on a quarterly basis. Fifteen months after implementing the curriculum, we performed a second chart review to document which biologic treatments were utilized.

Results: The Phase I data analysis identified a lower overall use of non-anti-TNF biologic therapies. Among these other biologic therapies, there was an increased use of rituximab ($21,887/4 doses) and abatacept ($29,785/year) over the less costly tofacitinib ($14,633/year). Fifteen months after instituting the ‘cost awareness curriculum’ we again analyzed the use of biologics. We found that there was increased used of tofacitinib and decreased use of both abatacept and rituximab. This change in practice habits represented a cost savings of $10,232/month or $122,794 over 15 months.

Conclusion: Biologic drugs are now commonly used in Rheumatology, Gastroenterology, Oncology, and many other specialties. In the United States, there is little competition for biologics, but some are less expensive, especially when comparing oral medications to those that require infusions or injections. Drug costs are not transparent and co-pays vary between insurance companies. Physicians often prescribe the drug that is deemed ‘first-line’ or ‘on formulary’ by insurance companies. However, as demonstrated here, once empowered with knowledge of drug costs, physicians are able to save the patient and institution money by practicing cost-conscious medical care and choosing the less costly medication. In our clinic, rheumatologists selected the lower cost medication more often following education on the costs of available biologics, saving $122,794 over the 15 month analysis period.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/survival-and-cost-of-biologic-dmards-in-a-military-medical-center-a-quality-improvement-initiative/