title: Cost and Resource Use of Pemphigus and Pemphigoid Disorders Pre- and Post-Rituximab.
abstract: BACKGROUND
  Rituximab (RTX) is increasingly used for the treatment of pemphigus and pemphigoid disorders. The high cost of RTX frequently limits its use and access.
  
  
  OBJECTIVE
  To determine the health system resources and costs associated with RTX treatment of pemphigus and pemphigoid.
  
  
  METHODS
  Health system resources and costs attributed to a convenience sample of 89 patients with either pemphigus or pemphigoid were identified, quantified, and valued 6 months prior to and following RTX initiation between May 2006 and August 2012. Overall cohort costs and costs per patient were calculated (2013 Can$).
  
  
  RESULTS
  The overall cohort cost for 6 months pre-RTX was $3.8 million and for 6 months post-RTX was $2.6 million. The average cost per patient decreased from $42,231 to $29,423 (30.3% decrease). The main cost driver was intravenous immunoglobulin.
  
  
  CONCLUSIONS
  Our findings suggest that RTX is effective in reducing health system resources and the costs associated with the treatment of pemphigus and pemphigoid.
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON karaheelan@yahoo.com.
authors.forename: Kara
authors.initials: K
authors.lastname: Heelan
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON.
authors.forename: Shazia
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON.
authors.forename: Grace
authors.initials: G
authors.lastname: Bannon
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON.
authors.forename: Sandra
authors.initials: S
authors.lastname: Knowles
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON.
authors.forename: Scott
authors.initials: S
authors.lastname: Walsh
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
authors.affiliation: Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ONHealth Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ONDivision of Clinical Pharmacology and Toxicology at Sunnybrook, Department of Medicine, University of Toronto, Toronto, ONDepartment of Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ONInternational Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics* / Q000627:therapeutic use*; D002170:Canada; D016527:Drug Costs; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000188:drug therapy* / Q000191:economics; D010392:Pemphigus / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D000069283:Rituximab; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab