Market Access, MSD Sharp & Dohme GmbH, Haar, Germany.
Gesundheitsforen Leipzig GmbH, Leipzig, Germany.
Eur J Health Econ. 2019 Mar;20(2):195-203. doi: 10.1007/s10198-017-0953-z. Epub 2018 Jan 23.
We determined adalimumab utilisation and associated drug costs in patients with ulcerative colitis (UC), focusing on patients requiring dose escalation.
The retrospective cohort study analysed the de-identified prescription data of the Arvato Health Analytics (Munich, Germany) database (2010-2015) in adult UC patients undergoing adalimumab therapy.
A total of 154 patients were newly treated with adalimumab (average 39.6 years, 53% females), with a mean dose of 2.93 mg/day. Within 12 months, 69 patients (45%) received a dose increase of > 50% (doubled dose in 48 patients; 32%), with the escalation reported at 169.3 ± 99.3 days. A subsequent dose de-escalation to the standard dose occurred in 50 (32%) of patients that initially had a dose increase of > 50% (after 94.7 ± 49.6 days). Direct drug costs were 28,846 € in the overall study population, 24,934 € in patients on standard dose, 36,094 € in patients with dose increase, and 32,742 € in patients with increase and subsequent decrease.
Dose escalation occurred frequently, and in one third of patients the dose was at least doubled. Dose escalations were associated with substantial increases in direct drug costs. Dose escalation of adalimumab can severely affect both the health care system and the drug budget of the physician. It needs to be considered that other biologic medications may constitute a more cost-effective alternative.
我们旨在确定溃疡性结肠炎（UC）患者中阿达木单抗的使用情况和相关药物费用，重点关注需要剂量升级的患者。
这项回顾性队列研究分析了 Arvato Health Analytics（德国慕尼黑）数据库（2010-2015 年）中接受阿达木单抗治疗的成年 UC 患者的匿名处方数据。
共有 154 名患者新接受阿达木单抗治疗（平均年龄 39.6 岁，53%为女性），平均剂量为 2.93mg/天。在 12 个月内，69 名患者（45%）的剂量增加了>50%（48 名患者加倍剂量；32%），剂量升级报告时间为 169.3±99.3 天。最初剂量增加>50%的 50 名患者（32%）随后将剂量降低至标准剂量（增加后 94.7±49.6 天）。在整个研究人群中，直接药物费用为 28846 欧元，标准剂量患者为 24934 欧元，剂量增加患者为 36094 欧元，剂量增加和随后减少患者为 32742 欧元。
剂量升级频繁发生，三分之一的患者至少将剂量加倍。剂量升级与直接药物费用的大幅增加相关。阿达木单抗的剂量升级可能会严重影响医疗保健系统和医生的药物预算。需要考虑到其他生物药物可能构成更具成本效益的替代方案。
