Yang Min, Galebach Philip J, Signorovitch James E, Garg Vishvas
Analysis Group, Inc., Boston, MA, USA.
AbbVie Inc., North Chicago, IL, USA.
Clin Exp Rheumatol. 2017 Sep-Oct;35(5):791-798. Epub 2017 Mar 23.
We assessed the level of maintained effectiveness and associated healthcare costs in stabilised rheumatoid arthritis (RA) patients who reduced doses of adalimumab or etanercept.
Eligible patients were identified from a U.S. commercial insurance database using the following criteria: adults with ≥2 RA diagnoses; effectively treated on standard dose of adalimumab or etanercept for a 6-month baseline period; and ≥3 months of dose reduction within a 6-month assessment period following the index date (date of the first reduced dose). Effectiveness was estimated using a validated claims-based algorithm. Multivariate regression models were used to assess maintained effectiveness and healthcare costs in the short-term (months 7-12) and long-term (months 13-24) following the index date, while adjusting for baseline characteristics. Cost per patient maintaining effective treatment (CPME) was calculated as the average total healthcare costs divided by the proportion of patients with maintained effectiveness.
Both groups (etanercept=375; adalimumab=610) had 70% females and a mean age of 48 years. Adjusted rates of maintained effectiveness for etanercept vs. adalimumab were 57.5% vs. 64.7% (p=0.028) in the short-term and 44.3% vs. 51.9% (p=0.047) in the long-term. Adjusted healthcare costs were similar for etanercept- and adalimumab-treated patients (short-term: $15,043 vs. $15,041; long-term: $31,461 vs. $30,449). The CPME was $2,915 higher with etanercept-treated patients in short-term and $12,349 higher in long-term compared with adalimumab-treated patients.
Among stabilised RA patients who reduced biologic dosing, a greater proportion of adalimumab-treated patients maintained effectiveness than etanercept-treated patients. Adalimumab was associated with a lower total CPME than etanercept.
我们评估了降低阿达木单抗或依那西普剂量的病情稳定的类风湿关节炎（RA）患者的维持疗效水平及相关医疗费用。
从美国商业保险数据库中根据以下标准确定符合条件的患者：患有≥2次RA诊断的成年人；在6个月的基线期接受标准剂量阿达木单抗或依那西普有效治疗；在索引日期（首次减量日期）后的6个月评估期内有≥3个月的剂量减少。使用经过验证的基于索赔的算法评估疗效。多变量回归模型用于评估索引日期后的短期（第7 - 12个月）和长期（第13 - 24个月）的维持疗效和医疗费用，同时对基线特征进行调整。维持有效治疗的每位患者成本（CPME）计算为平均总医疗费用除以维持疗效的患者比例。
两组（依那西普组 = 375例；阿达木单抗组 = 610例）女性均占70%，平均年龄为48岁。依那西普与阿达木单抗的短期维持有效率调整后分别为57.5%和64.7%（p = 0.028），长期分别为44.3%和51.9%（p = 0.047）。依那西普和阿达木单抗治疗的患者调整后的医疗费用相似（短期：15,043美元对15,041美元；长期：31,461美元对30,449美元）。与阿达木单抗治疗的患者相比，依那西普治疗的患者短期CPME高2,915美元，长期高12,349美元。
在降低生物制剂剂量的病情稳定的RA患者中，接受阿达木单抗治疗的患者维持疗效的比例高于接受依那西普治疗的患者。与依那西普相比，阿达木单抗的总CPME较低。
