title: Estimating effectiveness and cost of biologics for rheumatoid arthritis: application of a validated algorithm to commercial insurance claims.
abstract: OBJECTIVE
  The aim of this analysis was to implement a claims-based algorithm to estimate biologic cost per effectively treated patient for biologics approved for moderate to severe rheumatoid arthritis (RA).
  
  
  METHODS
  This retrospective analysis included commercially insured adults (aged 18-63 years) with RA in a commercial database, who initiated biologic treatment with abatacept, adalimumab, etanercept, golimumab, or infliximab between 2007 and 2010. The algorithm defined effectiveness as having all of the following: high adherence, no biologic dose increase, no biologic switching, no new nonbiologic disease-modifying antirheumatic drug, no increased or new oral glucocorticoid use, and no more than 1 glucocorticoid injection. For each biologic, cost per effectively treated patient was defined as total drug and administration costs (from allowed amounts on claims), divided by the number of patients categorized as effectively treated.
  
  
  RESULTS
  Of 15,351 patients, 12,018 (78.3%) were women, and the mean (SD) age was 49.7 (9.6) years. The algorithm categorized treatment as effective in the first year for 30% (1899/6374) of etanercept, 30% (1396/4661) of adalimumab, 20% (560/2765) of infliximab, 27% (361/1338) of abatacept, and 29% (62/213) of golimumab treated patients. The 1-year biologic cost per effectively treated patient, as defined by the algorithm, was nominally lower for subcutaneously injected biologics than for infused biologics. The 1-year biologic cost per effectively treated patient, as defined by the algorithm, was lowest for etanercept ($49,952), followed by golimumab ($50,189), adalimumab ($52,858), abatacept ($71,866), and infliximab ($104,333).
  
  
  CONCLUSIONS
  Algorithm-defined effectiveness was similar for biologics other than infliximab. The 1-year biologic cost per effectively treated patient, as defined by the algorithm, was nominally lower for subcutaneously injected biologics than for infused biologics.
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham, Alabama; Department of Epidemiology, University of Alabama, Birmingham, Alabama. Electronic address: jcurtis@uab.edu.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.affiliation: IMS Health, Alexandria, Virginia.
authors.forename: Vernon F
authors.initials: VF
authors.lastname: Schabert
authors.affiliation: Global Health Economics, Amgen Inc, Thousand Oaks, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Harrison
authors.affiliation: IMS Health, Alexandria, Virginia.
authors.forename: Jason
authors.initials: J
authors.lastname: Yeaw
authors.affiliation: IMS Health, Alexandria, Virginia.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Korn
authors.affiliation: Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Caroleen
authors.initials: C
authors.lastname: Quach
authors.affiliation: Department of Epidemiology, University of Alabama, Birmingham, Alabama.
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.affiliation: Global Health Economics, Amgen Inc, Thousand Oaks, California.
authors.forename: George J
authors.initials: GJ
authors.lastname: Joseph
authors.affiliation: Inflammation/Development, Amgen Inc, Thousand Oaks, California.
authors.forename: David H
authors.initials: DH
authors.lastname: Collier
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D001688:Biological Products / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: algorithm; biologics; claims; cost; effectiveness; rheumatoid arthritis