Wu Ning, Bhurke Sharvari, Shah Neel, Harrison David J
Health Economics and Epidemiology, Evidera, Lexington, MA, USA.
Amgen Inc., Thousand Oaks, CA, USA.
Clinicoecon Outcomes Res. 2015 May 13;7:257-66. doi: 10.2147/CEOR.S83932. eCollection 2015.
Several biologic medicines are available to treat rheumatoid arthritis (RA), and they differ in administration method (subcutaneous or intravenous [IV]). We analyzed a pharmacy benefit manager database to estimate claims-based, algorithm-determined effectiveness and cost per effectively treated patient for biologics used to treat RA.
We analyzed the Medco Health Solutions pharmacy benefit manager database to identify patients with one or more claims for a biologic used to treat RA from 2007 to 2012. The first observed claim defined the index date, the previous 180 days were the pre-index period, and follow-up was 365 days after the index date. Effectiveness of a biologic was determined by a validated, published algorithm designed for use in claims database analyses. Cost per effectively treated patient as determined by the algorithm was calculated as the total annual cost of the biologic therapy divided by the number of effectively treated patients. Analyses were conducted for subcutaneous, IV, and individual biologics.
The analysis population was 1,090 patients (subcutaneous: 785, IV: 305; etanercept: 440, adalimumab: 345, infliximab: 201, abatacept: 104). The mean age was 49.7±9.4 years, and 78% of the patients were female. Effectiveness according to the algorithm was higher in subcutaneous (36%) versus IV biologics (23%; P<0.001), and in etanercept (36%) versus infliximab (22%; P<0.001) and versus abatacept (24%; P=0.02). Etanercept and adalimumab were similar (35%; P=0.77). The cost per effectively treated patient according to the algorithm was $64,738 for subcutaneous biologics, $80,408 for IV biologics, $62,841 for etanercept, $67,226 for adalimumab, $90,696 for infliximab, and $62,303 for abatacept.
Effectiveness according to a validated, claims-based algorithm was higher in subcutaneous versus IV biologics. Cost per effectively treated patient according to the algorithm was approximately $16,000 less in subcutaneous versus IV biologics.
有几种生物药物可用于治疗类风湿关节炎（RA），它们在给药方式（皮下注射或静脉注射[IV]）上有所不同。我们分析了一个药房效益管理数据库，以估算用于治疗RA的生物制剂基于索赔、由算法确定的有效性以及每位有效治疗患者的成本。
我们分析了美可保健解决方案药房效益管理数据库，以识别在2007年至2012年期间有一项或多项用于治疗RA的生物制剂索赔的患者。首次观察到的索赔定义为索引日期，前180天为索引前期，随访为索引日期后的365天。生物制剂的有效性由一种经过验证、已发表的算法确定，该算法专为索赔数据库分析而设计。算法确定的每位有效治疗患者的成本计算为生物治疗的年度总成本除以有效治疗患者的数量。对皮下注射、静脉注射和各生物制剂进行了分析。
分析人群为1090例患者（皮下注射：785例，静脉注射：305例；依那西普：440例，阿达木单抗：345例，英夫利昔单抗：201例，阿巴西普：104例）。平均年龄为49.7±9.4岁，78%的患者为女性。根据算法，皮下生物制剂的有效性（36%）高于静脉注射生物制剂（23%；P<0.001），依那西普（36%）高于英夫利昔单抗（22%；P<0.001）和阿巴西普（24%；P=0.02）。依那西普和阿达木单抗相似（35%；P=0.77）。根据算法，皮下生物制剂每位有效治疗患者的成本为64,738美元，静脉注射生物制剂为80,408美元，依那西普为62,841美元，阿达木单抗为67,226美元，英夫利昔单抗为90,696美元，阿巴西普为62,303美元。
根据经过验证的基于索赔的算法，皮下生物制剂的有效性高于静脉注射生物制剂。根据算法，皮下生物制剂每位有效治疗患者的成本比静脉注射生物制剂约低16,000美元。
