Curtis Jeffrey R, Schabert Vernon F, Harrison David J, Yeaw Jason, Korn Jonathan R, Quach Caroleen, Yun Huifeng, Joseph George J, Collier David H
Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, Alabama; Department of Epidemiology, University of Alabama, Birmingham, Alabama.
IMS Health, Alexandria, Virginia.
Clin Ther. 2014 Jul 1;36(7):996-1004. doi: 10.1016/j.clinthera.2014.05.062. Epub 2014 Jul 8.
The aim of this analysis was to implement a claims-based algorithm to estimate biologic cost per effectively treated patient for biologics approved for moderate to severe rheumatoid arthritis (RA).
This retrospective analysis included commercially insured adults (aged 18-63 years) with RA in a commercial database, who initiated biologic treatment with abatacept, adalimumab, etanercept, golimumab, or infliximab between 2007 and 2010. The algorithm defined effectiveness as having all of the following: high adherence, no biologic dose increase, no biologic switching, no new nonbiologic disease-modifying antirheumatic drug, no increased or new oral glucocorticoid use, and no more than 1 glucocorticoid injection. For each biologic, cost per effectively treated patient was defined as total drug and administration costs (from allowed amounts on claims), divided by the number of patients categorized as effectively treated.
Of 15,351 patients, 12,018 (78.3%) were women, and the mean (SD) age was 49.7 (9.6) years. The algorithm categorized treatment as effective in the first year for 30% (1899/6374) of etanercept, 30% (1396/4661) of adalimumab, 20% (560/2765) of infliximab, 27% (361/1338) of abatacept, and 29% (62/213) of golimumab treated patients. The 1-year biologic cost per effectively treated patient, as defined by the algorithm, was nominally lower for subcutaneously injected biologics than for infused biologics. The 1-year biologic cost per effectively treated patient, as defined by the algorithm, was lowest for etanercept ($49,952), followed by golimumab ($50,189), adalimumab ($52,858), abatacept ($71,866), and infliximab ($104,333).
Algorithm-defined effectiveness was similar for biologics other than infliximab. The 1-year biologic cost per effectively treated patient, as defined by the algorithm, was nominally lower for subcutaneously injected biologics than for infused biologics.
本分析的目的是实施一种基于索赔的算法，以估算获批用于中重度类风湿性关节炎（RA）的生物制剂每有效治疗一名患者的成本。
这项回顾性分析纳入了商业数据库中年龄在18至63岁之间患有RA的商业保险成年人，他们在2007年至2010年间开始使用阿巴西普、阿达木单抗、依那西普、戈利木单抗或英夫利昔单抗进行生物治疗。该算法将有效性定义为具备以下所有条件：高依从性、生物制剂剂量未增加、未更换生物制剂、未使用新的非生物类改善病情抗风湿药物、口服糖皮质激素未增加或未使用新药，且糖皮质激素注射不超过1次。对于每种生物制剂，每有效治疗一名患者的成本定义为总药物和给药成本（根据索赔允许金额）除以被归类为有效治疗的患者数量。
在15351名患者中，12018名（78.3%）为女性，平均（标准差）年龄为49.7（9.6）岁。该算法将第一年的治疗归类为有效的患者比例为：接受依那西普治疗的患者中有30%（1899/6374）、接受阿达木单抗治疗的患者中有30%（1396/4661）、接受英夫利昔单抗治疗的患者中有20%（560/2765）、接受阿巴西普治疗的患者中有27%（361/1338）以及接受戈利木单抗治疗的患者中有29%（62/213）。根据该算法定义，每有效治疗一名患者的1年生物制剂成本，皮下注射生物制剂名义上低于静脉注射生物制剂。根据该算法定义，每有效治疗一名患者的1年生物制剂成本，依那西普最低（49952美元），其次是戈利木单抗（50189美元）、阿达木单抗（52858美元）、阿巴西普（71866美元）和英夫利昔单抗（104333美元）。
除英夫利昔单抗外，算法定义的生物制剂有效性相似。根据该算法定义，每有效治疗一名患者的1年生物制剂成本，皮下注射生物制剂名义上低于静脉注射生物制剂。
