Johnson Courtney, Stephens Jennifer, Walker Christopher, Cappelleri Joseph C, Shelbaya Ahmed
Pharmerit International, Real World Evidence and Data Analytics, Bethesda, MD, USA.
Pfizer Ltd., Global Medical Affairs, Tadworth, Surrey, England.
Clinicoecon Outcomes Res. 2020 Jan 21;12:57-67. doi: 10.2147/CEOR.S199145. eCollection 2020.
This study describes treatment patterns, healthcare resource utilization (HCRU), and costs associated with persistence, switching, and dosing of branded celecoxib in osteoarthritis (OA) patients.
This retrospective claims database analysis used MarketScan Commercial Claims and Encounters (MarketScan) data from 2009 to 2013. Included patients were adult (≥ 18 years), incident celecoxib users with ≥ 1 OA claim. The treatment switch analysis analyzed outcomes in patients persistent on celecoxib versus switched to a generic nonsteroidal anti-inflammatory drug (NSAID). The dosing analysis stratified patients as under-dose (<200 mg per day) and standard dose (≥200 mg per day). HCRU, costs, and treatment duration were compared in persistent versus switched and standard dose versus under-dose patients using descriptive, multivariate logistic regression, and Kaplan-Meier analysis.
A total of 65,530 patients met the inclusion criteria. During follow-up, 83% discontinued celecoxib without switching, 10% were persistent, and 5% switched to a generic NSAID. Ninety percent received a standard dose of celecoxib. Switched (versus persistent) patients had significantly higher all-cause hospital admissions, length of stay, emergency room (ER) visits, and office visits per person year (PPY), all <0.001; and under-dosed (versus standard dose) patients had significantly higher hospital admissions (<0.001), length of stay (<0.001), and ER visits (= 0.021) PPY. Persistent versus switched patients had lower mean total all-cause costs PPY ($20,378 vs $23,949, <0.001). Standard dose versus under-dose patients had lower mean total all-cause costs ($23,680 vs $26,955 PPY, <0.001), and not statistically significant higher mean total OA-related costs ($5698 vs $5524 PPY, =0.441).
Patients that switched from branded celecoxib to a generic NSAID or received an under-dose of branded celecoxib had higher average overall HCRU and costs. OA-related inpatient and outpatient cost savings may offset the higher drug cost of celecoxib for persistent patients.
本研究描述了骨关节炎（OA）患者中与品牌塞来昔布的持续用药、换药及给药剂量相关的治疗模式、医疗资源利用（HCRU）情况及成本。
本回顾性索赔数据库分析使用了2009年至2013年的MarketScan商业索赔和病历数据（MarketScan）。纳入患者为成年人（≥18岁），首次使用塞来昔布且有≥1次OA索赔记录。治疗换药分析比较了持续使用塞来昔布的患者与换用非甾体抗炎药（NSAID）仿制药的患者的结局。剂量分析将患者分为低剂量组（<200毫克/天）和标准剂量组（≥200毫克/天）。使用描述性分析、多变量逻辑回归分析和Kaplan-Meier分析比较了持续用药组与换药组以及标准剂量组与低剂量组患者的HCRU、成本和治疗持续时间。
共有65,530名患者符合纳入标准。在随访期间，83%的患者未换药就停用了塞来昔布，10%的患者持续用药，5%的患者换用了NSAID仿制药。90%的患者接受了标准剂量的塞来昔布。换药组（与持续用药组相比）患者的全因住院次数、住院时长、急诊室（ER）就诊次数和每人每年（PPY）的门诊就诊次数显著更高，P值均<0.001；低剂量组（与标准剂量组相比）患者的住院次数（<0.001）、住院时长（<0.001）和ER就诊次数（=0.021）PPY显著更高。持续用药组与换药组患者的平均全因总成本PPY较低（20,378美元对23,949美元，<0.001）。标准剂量组与低剂量组患者的平均全因总成本较低（23,680美元对26,955美元PPY，<0.001），且平均OA相关总成本差异无统计学意义（5698美元对5524美元PPY，=0.441）。
从品牌塞来昔布换用NSAID仿制药或接受低剂量品牌塞来昔布治疗的患者，其平均总体HCRU和成本更高。与OA相关的住院和门诊成本节省可能会抵消持续用药患者使用塞来昔布较高的药物成本。
