Palmer Jacqueline B, Li Yunfeng, Herrera Vivian, Liao Minlei, Tran Melody, Ozturk Zafer E
Immunology and Dermatology, Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA.
Outcomes Research Methods & Analytics, US Health Economics & Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, 07936-1080, USA.
BMC Musculoskelet Disord. 2016 Jun 14;17:261. doi: 10.1186/s12891-016-1102-z.
Real-world data regarding anti-tumor necrosis factor alpha (anti-TNFα) biologic therapy use in psoriatic arthritis (PsA) are limited; therefore, we described treatment patterns and costs of anti-TNFα therapy in PsA patients in the United States.
PsA patients (N = 990) aged ≥18 years who initiated anti-TNFα therapy were selected from MarketScan claims databases (10/1/2009 to 9/30/2010). Number of patients on first- (n = 881), second- (n = 72), or third- or greater (n = 37) line of anti-TNFα therapy, persistence, time-to-switch or modification, pharmacy and medical costs (measured per patient per month [PPPM]) for each line of therapy were observed during the 3-year follow-up.
PsA patients receiving only one line of anti-TNFα therapy remained on first-line for ~17 months while those who switched to second- or third- or greater persisted on first-line for ~11 to 12 months, respectively. Time to first-line modification was longer for patients who switched to third- or greater line therapy (7 months) than those who did not switch or switched to second-line (range, ~2 to 4 months). Time-to-switch and time to first-line modification was progressively shorter with each line of therapy for patients who received third- or greater line. PPPM medical costs were higher for patients who did not switch ($322) than those who switched to second- ($167) or third- or greater ($217) line. PPPM pharmacy costs were greater for patients with third- or greater line therapy ($2539) than those who did not switch ($1985) or switched to second-line ($2045).
While the majority of patients received only one line of anti-TNFα therapy, a subset of patients switched to multiple lines of therapy during the 3-year follow-up period. Persistence and therapy modifications differed between these patients and those receiving only one line. Overall medical costs were highest for patients who did not switch, and pharmacy costs increased as patients switched to each new line of therapy.
关于抗肿瘤坏死因子α（抗TNFα）生物疗法用于银屑病关节炎（PsA）的真实世界数据有限；因此，我们描述了美国PsA患者抗TNFα治疗的模式和成本。
从MarketScan索赔数据库（2009年10月1日至2010年9月30日）中选取年龄≥18岁且开始抗TNFα治疗的PsA患者（N = 990）。在3年随访期间，观察接受一线（n = 881）、二线（n = 72）或三线及以上（n = 37）抗TNFα治疗的患者数量、持续时间、换药或调整治疗的时间，以及每线治疗的药房和医疗成本（按每位患者每月[PPPM]计算）。
仅接受一线抗TNFα治疗的PsA患者在一线治疗持续约17个月，而转为二线或三线及以上治疗的患者在一线治疗分别持续约11至12个月。转为三线及以上治疗的患者一线治疗调整时间（7个月）比未换药或转为二线治疗的患者更长（范围约为2至4个月）。接受三线及以上治疗的患者，随着每线治疗，换药时间和一线治疗调整时间逐渐缩短。未换药患者的PPPM医疗成本（$322）高于转为二线（$167）或三线及以上（$217）治疗的患者。三线及以上治疗患者的PPPM药房成本（$2539）高于未换药患者（$1985）或转为二线治疗的患者（$2045）。
虽然大多数患者仅接受一线抗TNFα治疗，但在3年随访期间，有一部分患者转为接受多线治疗。这些患者与仅接受一线治疗的患者在持续时间和治疗调整方面存在差异。未换药患者的总体医疗成本最高，随着患者转为每一新的治疗线，药房成本增加。
