Research Excellence & Personalized Patient Care, Oregon Medical Research Center, Portland, OR, USA.
Truven Health Analytics, Truven Health Analytics, IBM Watson Health, Cambridge, MA, USA.
J Med Econ. 2022 Jan-Dec;25(1):741-749. doi: 10.1080/13696998.2022.2081417.
To compare long-term healthcare resource utilization (HCRU) and costs among patients who initiated ixekizumab (IXE) or adalimumab (ADA) for treatment of psoriasis in the United States.
Adult patients with psoriasis who had ≥1 claim for IXE or ADA were identified from IBM MarketScan claims databases prior to the COVID-19 pandemic (1 March 2016-31 October 2019). The index date was the date of first claim for the index drug of interest. Inverse probability of treatment weighting was employed to balance treatment cohorts. All-cause and psoriasis-related HCRU and costs were examined for 24 months of follow-up. Costs were reported as per patient per month. Costs of psoriasis-related biologics were adjusted using published Institute for Clinical and Economic Review (ICER) discount factors. Index drug costs were adjusted for adherence and ICER discount rates.
The analyses included 407 IXE and 2,702 ADA users. IXE users had significantly higher inpatient admission rate (all-cause HCRU: 14.9% vs. 11.0%; =0.012) and greater mean length of stay per admission (days, 6.6 vs. 4.1; =0.004) than ADA users. ICER-adjusted costs were significantly higher in IXE than ADA users (all-cause costs: $4,132 vs. $3,610; <0.001; psoriasis-related costs $3,077 vs. $2,700; <0.001). After adjusting for ICER and adherence, IXE and ADA drug costs were comparable ($3,636 vs. $3,677; =0.714).
Study relied on administrative claims data, subjected to data coding limitations and data entry errors. Rebates, patient assistance programs, and commission to wholesalers are not always captured in claims. Adjustment made by ICER discount factors may lead to double-discounting if the discounts have been applied in claim payments.
All-cause HCRU was higher in IXE than ADA users. Healthcare costs were also higher in IXE than ADA users after ICER adjustment, over 24 months. Cost differences were largely driven by higher treatment adherence associated with IXE. Index drug costs were comparable after ICER and adherence adjustments.
比较美国接受依奇珠单抗（IXE）或阿达木单抗（ADA）治疗银屑病的患者长期医疗资源利用（HCRU）和成本。
在 COVID-19 大流行之前（2016 年 3 月 1 日至 2019 年 10 月 31 日），从 IBM MarketScan 索赔数据库中确定了至少有 1 项 IXE 或 ADA 索赔的成年银屑病患者。索引日期是首次使用感兴趣的索引药物的日期。采用逆概率治疗加权法平衡治疗队列。在 24 个月的随访期间，检查了所有原因和银屑病相关的 HCRU 和成本。以每位患者每月为单位报告成本。使用已发表的临床和经济审查研究所（ICER）折扣因素调整了银屑病相关生物制剂的成本。根据药物依从性和 ICER 折扣率调整了索引药物的成本。
分析纳入了 407 名 IXE 和 2702 名 ADA 用户。IXE 用户的住院入院率（所有原因 HCRU：14.9% vs. 11.0%； =0.012）和每次入院的平均住院天数（6.6 天 vs. 4.1 天； =0.004）均显著高于 ADA 用户。经 ICER 调整后，IXE 用户的成本明显高于 ADA 用户（所有原因成本：$4132 与 $3610； <0.001；银屑病相关成本：$3077 与 $2700； <0.001）。调整了 ICER 和药物依从性后，IXE 和 ADA 的药物成本相当（$3636 与 $3677； =0.714）。
研究依赖于行政索赔数据，受数据编码限制和数据输入错误的影响。回扣、患者援助计划和批发商佣金并不总是在索赔中记录。如果折扣已经在索赔支付中应用，则 ICER 折扣因素的调整可能导致双重折扣。
IXE 用户的所有原因 HCRU 均高于 ADA 用户。在调整了 ICER 后，IXE 用户的医疗保健成本也高于 ADA 用户，在 24 个月的时间内。成本差异主要归因于 IXE 相关的更高治疗依从性。调整了 ICER 和药物依从性后，索引药物的成本相当。
