University of Alabama at Birmingham , Birmingham, AL , USA.
J Med Econ. 2014 Aug;17(8):555-66. doi: 10.3111/13696998.2014.914031. Epub 2014 May 14.
To estimate biologic cost per effectively treated patient with rheumatoid arthritis (RA) using a claims-based algorithm for effectiveness.
Patients with RA aged 18-63 years in the IMS PharMetrics Plus database were categorized as effectively treated if they met all six criteria: (1) a medication possession ratio ≥80% (subcutaneous) or at least as many infusions as specified in US labeling (intravenous); (2) no biologic dose increase; (3) no biologic switch; (4) no new non-biologic disease-modifying anti-rheumatic drug; (5) no new or increased oral glucocorticoid; and (6) ≤1 glucocorticoid injection. Biologic cost per effectively treated patient was defined as total cost of the index biologic (drug plus intravenous administration) divided by the number of patients categorized by the algorithm as effectively treated. Similar methods were used for the index biologic in the second year and for a second biologic after a switch.
Rates that the index biologic was categorized as effective in the first year were 31.0% etanercept (2243/7247), 28.6% adalimumab (1426/4991), 28.6% abatacept (332/1160), 27.2% golimumab (71/261), and 20.2% infliximab (474/2352). Mean biologic cost per effectively treated patient, per the algorithm, was $50,141 etanercept, $53,386 golimumab, $56,942 adalimumab, $73,516 abatacept, and $114,089 infliximab. Biologic cost per effectively treated patient, using this algorithm, was lower for patients who continued the index biologic in the second year and higher after switching.
When a claims-based algorithm was applied to a large commercial claims database, etanercept was categorized as the most effective and had the lowest estimated 1-year biologic cost per effectively treated patient. This proxy for effectiveness from claims databases was validated against a clinical effectiveness scale, but analyses of the second year or the year after a biologic switch were not included in the validation. Costs of other medications were not included in cost calculations.
使用基于索赔的有效性算法估算每例有效治疗的类风湿关节炎（RA）患者的生物成本。
IMS PharMetrics Plus 数据库中年龄在 18-63 岁的 RA 患者，如果符合以下所有六项标准，则被归类为有效治疗：（1）药物占有率≥80%（皮下）或至少与美国标签规定的次数相同（静脉内）；（2）无生物剂量增加；（3）无生物转换；（4）无新的非生物疾病修饰抗风湿药物；（5）无新的或增加的口服糖皮质激素；（6）≤1 次糖皮质激素注射。每位有效治疗患者的生物成本定义为索引生物的总费用（药物加静脉注射）除以通过算法归类为有效治疗的患者人数。第二年索引生物和转换后的第二种生物也使用类似的方法。
第一年被归类为有效治疗的索引生物的比率分别为依那西普（2243/7247）31.0%、阿达木单抗（1426/4991）28.6%、阿巴西普（332/1160）28.6%、戈利木单抗（71/261）27.2%和英夫利昔单抗（474/2352）20.2%。根据算法，每位有效治疗患者的平均生物成本分别为依那西普 50141 美元、戈利木单抗 53386 美元、阿达木单抗 56942 美元、阿巴西普 73516 美元和英夫利昔单抗 114089 美元。使用该算法，第二年继续使用索引生物的患者的生物治疗成本较低，而转换后的成本较高。
当使用基于索赔的算法应用于大型商业索赔数据库时，依那西普被归类为最有效，并且每位有效治疗患者的 1 年估计生物成本最低。来自索赔数据库的这种有效性代理已针对临床有效性量表进行了验证，但未包括在验证中的是第二年或生物转换后的一年的分析。成本计算中未包括其他药物的成本。
