title: Annual costs of tumor necrosis factor inhibitors using real-world data in a commercially insured population in the United States.
abstract: OBJECTIVE
  To calculate annual cost per treated patient of tumor necrosis factor (TNF) inhibitors etanercept, adalimumab, and infliximab for common approved indications, based on actual TNF-inhibitor use in clinical practice.
  
  
  METHODS
  Adults with ≥1 claim for etanercept, adalimumab, or infliximab between January 2005 and March 2009 were identified from the IMS LifeLink™ Health Plan Claims Database. Patients new to therapy or continuing therapy (i.e., a prior claim for a TNF-inhibitor) were analyzed separately. Included patients had been enrolled from 180 days before the first TNF-inhibitor claim (index date) through 360 days after the index date and had a diagnosis during the pre-index period for rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis. Patients with Crohn's disease, ulcerative colitis, or juvenile idiopathic arthritis were excluded. Annual costs were calculated using wholesale acquisition costs for the TNF-inhibitor and Medicare Physician Fee Schedule for drug administration. Costs from restarting or switching TNF-inhibitor therapy during the first year were included.
  
  
  RESULTS
  A total of 27,704 patients (11,528 new, 16,176 continuing) had claims for etanercept, adalimumab, or infliximab, most commonly (65%) for treatment of rheumatoid arthritis. The most commonly used agent was etanercept (14,777 patients; 53%), followed by adalimumab (6862 patients; 25%) and infliximab (6065 patients; 22%). Annual cost per treated patient was etanercept $14,873, adalimumab $17,766, and infliximab $21,256 across all indications. Annual cost per treated patient by disease was (etanercept/adalimumab/infliximab): rheumatoid arthritis ($14,314/$17,700/$20,390), psoriasis ($17,182/$17,682/$23,935), psoriatic arthritis ($15,030/$18,483/$24,974), and ankylosing spondylitis ($14,254/$16,925/$23,056). New and continuing patients showed similar results, with etanercept having the lowest costs.
  
  
  CONCLUSIONS
  This analysis is limited to three TNF-inhibitors and a US managed-care population.
  
  
  CONCLUSIONS
  Based on this analysis of real-world use of TNF-inhibitors among patients in nationwide clinical practice settings, the annual TNF-inhibitor cost per treated patient was lowest for etanercept across all indications.
authors: IMS Health, Inc., Alexandria, VA 22314, USA. vschabert@imscg.com
authors: Vernon F
authors: VF
authors: Schabert
authors: Crystal
authors: C
authors: Watson
authors: Shravanthi R
authors: SR
authors: Gandra
authors: Seth
authors: S
authors: Goodman
authors: Kathleen M
authors: KM
authors: Fox
authors: David J
authors: DJ
authors: Harrison
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011306:Prescription Fees / Q000639:trends*; D012216:Rheumatic Diseases / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000191:economics* / Q000627:therapeutic use; D014481:United States
chemical_list: D014409:Tumor Necrosis Factor-alpha