Soini Erkki J, Leussu Miina, Hallinen Taru
ESiOR Ltd, Tulliportinkatu 2 LT4, 70100 Kuopio, Finland.
Springerplus. 2013 Oct 17;2:531. doi: 10.1186/2193-1801-2-531. eCollection 2013.
Cost-effectiveness studies explicitly reporting infusion times, drug-specific administration costs for infusions or real-payer intravenous drug cost are few in number. Yet, administration costs for infusions are needed in the health economic evaluations assessing intravenously-administered drugs.
To estimate the drug-specific administration and total cost of biologic intravenous rheumatoid arthritis (RA) drugs in the adult population and to compare the obtained costs with published cost estimates.
Cost price data for the infusions and drugs were systematically collected from the 2011 Finnish price lists. All Finnish hospitals with available price lists were included. Drug administration and total costs (administration cost + drug price) per infusion were analysed separately from the public health care payer's perspective. Further adjustments for drug brand, dose, and hospital type were done using regression methods in order to improve the comparability between drugs. Annual expected drug administration and total costs were estimated. A literature search not limited to RA was performed to obtain the per infusion administration cost estimates used in publications. The published costs were converted to Finnish values using base-year purchasing power parities and indexing to the year 2011.
Information from 19 (95%) health districts was obtained (107 analysable prices out of 176 observations). The average drug administration cost for infliximab, rituximab, abatacept, and tocilizumab infusion in RA were €355.91; €561.21; €334.00; and €293.96, respectively. The regression-adjusted (dose, hospital type; using semi-log ordinary least squares) mean administration costs for infliximab and rituximab infusions in RA were €289.12 (95% CI €222.61-375.48) and €542.28 (95% CI €307.23-957.09). The respective expected annual drug administration costs were €2312.96 for infliximab during the first year, €1879.28 for infliximab during the forthcoming years, and €1843.75 for rituximab. The obtained average administration costs per infusion were higher (1.8-3.3 times depending on the drug) than the previously published purchasing power adjusted and indexed average administration costs for infusions in RA.
The administration costs of RA infusions vary between drugs, and more effort should be made to find realistic drug-specific estimates for cost-effectiveness evaluations. The frequent assumption of intravenous drug administration costs equalling outpatient visit cost can underestimate the costs.
明确报告输注时间、特定药物输注给药成本或实际支付方的静脉用药成本的成本效益研究数量较少。然而，在评估静脉给药药物的卫生经济评价中，需要输注给药成本。
估计成人群体中生物制剂静脉注射类风湿关节炎（RA）药物的特定药物给药及总成本，并将所得成本与已发表的成本估计值进行比较。
从2011年芬兰价格表中系统收集输注和药物的成本价格数据。纳入所有有可用价格表的芬兰医院。从公共医疗保健支付方的角度分别分析每次输注的药物给药及总成本（给药成本+药物价格）。为提高药物之间的可比性，使用回归方法对药物品牌、剂量和医院类型进行进一步调整。估计年度预期药物给药及总成本。进行不限于RA的文献检索，以获取出版物中使用的每次输注给药成本估计值。使用基年购买力平价并索引至2011年，将已发表的成本换算为芬兰货币价值。
获得了19个（95%）卫生区的信息（176个观察值中有107个可分析价格）。RA中英夫利昔单抗、利妥昔单抗、阿巴西普和托珠单抗输注的平均药物给药成本分别为355.91欧元、561.21欧元、334.00欧元和293.96欧元。RA中英夫利昔单抗和利妥昔单抗输注的回归调整后（剂量、医院类型；使用半对数普通最小二乘法）平均给药成本分别为289.12欧元（95%CI 222.61 - 375.48欧元）和542.28欧元（95%CI 307.23 - 957.09欧元）。英夫利昔单抗第一年的预期年度药物给药成本为2312.96欧元，后续年份为1879.28欧元，利妥昔单抗为1843.75欧元。获得的每次输注平均给药成本高于先前发表的经购买力调整和索引的RA输注平均给药成本（根据药物不同为1.8 - 3.3倍）。
RA输注的给药成本因药物而异，应做出更多努力以找到用于成本效益评估的实际特定药物估计值。静脉用药给药成本等于门诊就诊成本这一常见假设可能会低估成本。
