Pharmerit North America LLC - Modeling and Meta-Analysis, Bethesda, MD, USA.
Bristol-Myers Squibb Co - US Health Economics and Outcomes Research, Lawrence Township, NJ, USA.
J Med Econ. 2020 Jun;23(6):624-630. doi: 10.1080/13696998.2020.1732991. Epub 2020 May 19.
Given that rheumatoid arthritis (RA) patients with high anti-citrullinated protein antibodies (ACPA) titer values respond well to abatacept, the aim of this study was to estimate the annual budget impact of anti-cyclic citrullinated peptide (anti-CCP) testing and treatment selection based on anti-CCP test results. Budget impact analysis was conducted for patients with moderate-to-severe RA on biologic or Janus kinase inhibitor (JAKi) treatment from a hypothetical US commercial payer perspective. The following market scenarios were compared: (1) 90% of target patients receive anti-CCP testing and the results of anti-CCP testing do not impact the treatment selection; (2) 100% of target patients receive anti-CCP testing and the results of anti-CCP testing have an impact on treatment selection such that an increased proportion of patients with high titer of ACPA receive abatacept. A hypothetical assumption was made that the use of abatacept would be increased by 2% in Scenario 2 versus 1. Scenario analyses were conducted by varying the target population and rebate rates. In a hypothetical health plan with one million insured adults, 2,181 patients would be on a biologic or JAKi treatment for moderate-to-severe RA. In Scenario 1, the anti-CCP test cost was $186,155 and annual treatment cost was $101,854,295, totaling to $102,040,450. In Scenario 2, the anti-CCP test cost increased by $20,684 and treatment cost increased by $160,467, totaling an overall budget increase of $181,151. This was equivalent to a per member per month (PMPM) increase of $0.015. The budget impact results were consistently negligible across the scenario analyses. The analysis only considered testing and medication costs. Some parameters used in the analysis, such as the rebate rates, are not generalizable and health plan-specific. Testing RA patients to learn their ACPA status and increasing use of abatacept among high-titer ACPA patients result in a small increase in the total budget (<2 cents PMPM).
鉴于抗瓜氨酸化蛋白抗体 (ACPA) 滴度高的类风湿关节炎 (RA) 患者对阿巴西普反应良好，本研究旨在根据抗环瓜氨酸肽 (抗-CCP) 检测结果估算抗-CCP 检测和治疗选择的年度预算影响。从假设的美国商业支付者的角度，对接受生物制剂或 Janus 激酶抑制剂 (JAKi) 治疗的中重度 RA 患者进行预算影响分析。比较了以下市场情况：(1) 90%的目标患者接受抗-CCP 检测，且抗-CCP 检测结果不影响治疗选择；(2) 100%的目标患者接受抗-CCP 检测，且抗-CCP 检测结果影响治疗选择，使更多高滴度 ACPA 的患者接受阿巴西普治疗。假设在方案 2 中，与方案 1 相比，阿巴西普的使用量将增加 2%。通过改变目标人群和回扣率进行方案分析。在一个拥有 100 万参保成年人的假设健康计划中，有 2181 名患者正在接受中重度 RA 的生物制剂或 JAKi 治疗。在方案 1 中，抗-CCP 检测费用为 186155 美元，年度治疗费用为 101854295 美元，总计 102040450 美元。在方案 2 中，抗-CCP 检测费用增加了 20684 美元，治疗费用增加了 160467 美元，总预算增加了 181151 美元，相当于每个成员每月增加 0.015 美元。在整个方案分析中，预算影响结果均微不足道。该分析仅考虑了检测和药物治疗成本。在分析中使用的一些参数，如回扣率，不具有普遍性，而是针对特定的健康计划。检测 RA 患者以了解他们的 ACPA 状态，并增加高滴度 ACPA 患者中阿巴西普的使用，会导致总预算略有增加（每个成员每月增加不到 2 美分）。
