Background/Purpose: Golimumab is a 50 mg, once-monthly, patient-administered anti-tumor necrosis factor alpha (anti-TNF) therapy indicated for moderate to severe rheumatoid arthritis (RA), active psoriatic arthritis, or active ankylosing spondylitis. A substantial proportion of patients receive golimumab through a specialty pharmacy provider (SPP).  The purpose of this study is to describe the utilization and expected golimumab cost for RA patients receiving golimumab from a SPP.

Methods: Pharmacy and eNAVIGATOR^TM data were analyzed for adult patients with an ICD-9-CM diagnosis code for RA (714.X) who received ≥2 golimumab doses between 4/24/2009 and 8/24/2011. Utilization measures included the proportion of 50 mg dose fills and the proportion of compliant fills, defined as 21 to 38 days, corresponding to a 28 to 31 days supply +/- 7 days. Descriptive statistics were employed. Mean refill interval and wholesale acquisition cost (WAC) for golimumab ($2,075.62 per 50 mg; 2/1/2012- Analysource; First Databank) were used to estimate the annual cost of golimumab.

Results: The study population included 126 golimumab patients and was predominantly female (79%) and aged >45 years (72%). The majority (71%) reported prior biologic use. Of the 109 patients with baseline Health Assessment Questionnaire II (HAQ-II) assessments, a  score >1 was found in 62% (n=68).  A total of 942 golimumab fills were dispensed during the study period.  A 50 mg golimumab dose was dispensed in 100% of patients and 100% of fills. The mean (±SD) interval between golimumab doses was 35 ±22days (median 30 days).  The mean (±SD) refill interval of patients with prior-biologic use (bio-experienced) was 35 ±25 days with a median of 30 days. The mean (±SD) refill interval for patients without prior biologic therapy (bio-naïve) was 34±15 days with a median of 31 days. Approximately 84% of all fills fell within the defined compliance window for the overall population and in bio-experienced and bio-naïve subgroups.  Based upon a mean refill interval of 35 days, the average RA patient would have 11 golimumab fills per year at an estimated annual cost of $22,831.82. 

Conclusion: In this SPP population over a period of slightly more than two years, golimumab consistently was used at a 50 mg dose with a median refill interval of 30 days and mean refill  interval of 35 days. These findings correspond closely with dosing and administration recommendations in the golimumab product label. Overall refill compliance was observed in a high proportion of fills (greater than 80%). Based upon these utilization trends, the average annual cost of golimumab therapy was estimated to be $22,831.82.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilization-and-expected-cost-of-rheumatoid-arthritis-patients-treated-with-golimumab-a-specialty-pharmacy-perspective/