title: Use of a validated algorithm to estimate the annual cost of effective biologic treatment for rheumatoid arthritis.
abstract: OBJECTIVE
  To estimate biologic cost per effectively treated patient with rheumatoid arthritis (RA) using a claims-based algorithm for effectiveness.
  
  
  METHODS
  Patients with RA aged 18-63 years in the IMS PharMetrics Plus database were categorized as effectively treated if they met all six criteria: (1) a medication possession ratio ≥80% (subcutaneous) or at least as many infusions as specified in US labeling (intravenous); (2) no biologic dose increase; (3) no biologic switch; (4) no new non-biologic disease-modifying anti-rheumatic drug; (5) no new or increased oral glucocorticoid; and (6) ≤1 glucocorticoid injection. Biologic cost per effectively treated patient was defined as total cost of the index biologic (drug plus intravenous administration) divided by the number of patients categorized by the algorithm as effectively treated. Similar methods were used for the index biologic in the second year and for a second biologic after a switch.
  
  
  RESULTS
  Rates that the index biologic was categorized as effective in the first year were 31.0% etanercept (2243/7247), 28.6% adalimumab (1426/4991), 28.6% abatacept (332/1160), 27.2% golimumab (71/261), and 20.2% infliximab (474/2352). Mean biologic cost per effectively treated patient, per the algorithm, was $50,141 etanercept, $53,386 golimumab, $56,942 adalimumab, $73,516 abatacept, and $114,089 infliximab. Biologic cost per effectively treated patient, using this algorithm, was lower for patients who continued the index biologic in the second year and higher after switching.
  
  
  CONCLUSIONS
  When a claims-based algorithm was applied to a large commercial claims database, etanercept was categorized as the most effective and had the lowest estimated 1-year biologic cost per effectively treated patient. This proxy for effectiveness from claims databases was validated against a clinical effectiveness scale, but analyses of the second year or the year after a biologic switch were not included in the validation. Costs of other medications were not included in cost calculations.
authors.affiliation: University of Alabama at Birmingham , Birmingham, AL , USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Vernon F
authors.initials: VF
authors.lastname: Schabert
authors.forename: Jason
authors.initials: J
authors.lastname: Yeaw
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Korn
authors.forename: Caroleen
authors.initials: C
authors.lastname: Quach
authors.forename: David J
authors.initials: DJ
authors.lastname: Harrison
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.forename: George J
authors.initials: GJ
authors.lastname: Joseph
authors.forename: David
authors.initials: D
authors.lastname: Collier
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D001688:Biological Products / Q000191:economics*; D003365:Costs and Cost Analysis / Q000379:methods; D062313:Databases, Pharmaceutical; D006801:Humans; D008875:Middle Aged; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Algorithm; Biologics; Claims; Cost; Effectiveness; Rheumatoid arthritis