Feldman Steven R, Wu Jashin J, Rastogi Shipra, Menges Brandy, Lingohr-Smith Melissa, Lin Jay
a Wake Forest School of Medicine , Winston-Salem , NC , USA.
b Kaiser Permanente Los Angeles Medical Center , Los Angeles , CA , USA.
J Med Econ. 2018 May;21(5):537-541. doi: 10.1080/13696998.2018.1431920. Epub 2018 Feb 2.
Brodalumab is a new biologic approved by the US Food and Drug Administration in 2017 for the treatment of moderate-severe psoriasis. This study evaluated the impact of the introduction of brodalumab on the pharmacy budget on US commercial health plans.
An Excel-based health economic decision analytic model with a US health plan perspective was developed. The model incorporated published moderate-to-severe psoriasis prevalence data; market shares of common biologic drugs, including adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept, used for the treatment of moderate-severe psoriasis; 2017-year Wholesale Acquisition Costs for the biologic drugs; drug dispensing fee; patient co-pay; and drug contracting discount. Total annual health plan costs for the biologic drugs were estimated. Scenarios with different proportions of patients treated with brodalumab were compared to a control scenario when no brodalumab was used.
In a hypothetical commercial health plan covering two million members, 7,038 moderate-to-severe psoriasis patients were estimated to be eligible for treatment with brodalumab. Prior to brodalumab approval, the proportions of patients treated by other biologics were estimated at 50.8% for adalimumab, 13.5% for ustekinumab, 14.1% for secukinumab, 4.4% for ixekizumab, and 17.2% for etanercept. With a 20% drug price discount applied to all biologics, the annual health plan costs for brodalumab, adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept were estimated at $37,224, $49,166, $55,084, $56,061, $64,396, and $57,170, respectively. When no brodalumab is used, the total annual pharmacy budget for the biologics used among these patients was estimated at $414,362,647. Among scenarios where the proportions of brodalumab usage were 3%, 8%, 16%, and 30%, the total annual pharmacy cost was estimated to be reduced by $3,698,129, $9,861,677, $19,723,355, and $36,981,290, respectively.
Based on the economic model, brodalumab has the potential to substantially reduce pharmacy expenditures for the treatment of patients with moderate-to-severe plaque psoriasis in the US.
布罗达单抗是2017年美国食品药品监督管理局批准用于治疗中度至重度银屑病的一种新型生物制剂。本研究评估了布罗达单抗的引入对美国商业健康保险计划药房预算的影响。
建立了一个基于美国健康保险计划视角的、以Excel为基础的健康经济决策分析模型。该模型纳入了已发表的中度至重度银屑病患病率数据；用于治疗中度至重度银屑病的常见生物制剂（包括阿达木单抗、乌司奴单抗、司库奇尤单抗、依奇珠单抗和依那西普）的市场份额；这些生物制剂2017年的批发采购成本；药品配药费；患者自付费用；以及药品合同折扣。估算了生物制剂的年度健康保险计划总成本。将使用不同比例布罗达单抗治疗患者的情景与未使用布罗达单抗的对照情景进行比较。
在一个覆盖200万会员的假设商业健康保险计划中，估计有7038名中度至重度银屑病患者符合使用布罗达单抗治疗的条件。在布罗达单抗获批之前，估计使用其他生物制剂治疗的患者比例分别为：阿达木单抗50.8%、乌司奴单抗13.5%、司库奇尤单抗14.1%、依奇珠单抗4.4%、依那西普17.2%。若对所有生物制剂给予20%的药品价格折扣，布罗达单抗、阿达木单抗、乌司奴单抗、司库奇尤单抗、依奇珠单抗和依那西普的年度健康保险计划成本估计分别为37224美元、49166美元、55084美元、56061美元、64396美元和57170美元。当不使用布罗达单抗时，这些患者使用的生物制剂年度药房总预算估计为414362647美元。在布罗达单抗使用比例为3%、8%、16%和30%的情景中，年度药房总成本估计分别降低了3698129美元、9861677美元、19723355美元和36981290美元。
基于该经济模型，布罗达单抗有可能大幅降低美国中度至重度斑块状银屑病患者的治疗药房支出。
