Treatment patterns and annual biologic costs in US veterans with rheumatic conditions or psoriasis.
OBJECTIVE
To determine annual biologic drug and administration costs to the US Veterans Health Administration (VHA) per treated patient with rheumatoid arthritis (RA), psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who received abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab.


METHODS
Adults with at least one biologic claim between January 1, 2008 and December 31, 2011 were included. Evidence of enrollment in the VHA was required from 365 days before (pre-index) to 360 days after (post-index) the date of the first biologic claim (index date). Included patients had pre-index diagnoses of RA, PsO, PsA, and/or AS. Drug costs were from Federal Supply Schedule or 'Big Four' in November 2014. Administration costs were VHA fixed costs for infused ($169) and subcutaneous ($25) biologics.


RESULTS
Of the 20,465 patients in the analysis, 10,711 received etanercept, 7838 received adalimumab, and 1196 received infliximab as the index biologic. In these patients, across all uses studied, the VHA incurred greater annual cost per treated patient for infliximab ($18,066) compared with adalimumab ($16,523) and etanercept ($16,526). In the first year post-index, ∼80% of patients were either persistent on these index biologics or re-started these index biologics after a ≥45-day treatment gap. Other biologics comprised <5% of the study population, with sample sizes ranging from 3-374 patients each. Cost by indication for biologics used by >20 patients ranged from $15,056 (etanercept) to $17,050 (abatacept) for RA; $16,697 (adalimumab) to $33,163 (ustekinumab) for PsO; $15,035 (etanercept) to $20,465 (infliximab) for PsA; and $14,239 (etanercept) to $18,536 (infliximab) for AS.


CONCLUSIONS
The model was limited to the VHA. Results for biologics other than adalimumab, etanercept, and infliximab were difficult to interpret because of small sample sizes.


CONCLUSIONS
Infliximab has higher cost to the VHA than adalimumab or etanercept.
a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA.
Brian C
BC
Sauer
a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA.
Chia-Chen
CC
Teng
a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA.
Tao
T
He
a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA.
Jianwei
J
Leng
a a Health Services Research and Development (IDEAS Center), SLC VA Medical Center , Salt Lake City, UT, USA, and Epidemiology, University of Utah , Salt Lake City , UT , USA.
Chao-Chin
CC
Lu
b b Rheumatology, SLC VA Medical Center and University of Utah , Salt Lake City , UT , USA.
Jessica A
JA
Walsh
c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA.
Neel
N
Shah
c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA.
David J
DJ
Harrison
c c Global Health Economics, Amgen Inc. , Thousand Oaks , CA , USA.
Derek H
DH
Tang
b b Rheumatology, SLC VA Medical Center and University of Utah , Salt Lake City , UT , USA.
Grant W
GW
Cannon
D000293:Adolescent; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D004333:Drug Administration Routes; D005252:Fees, Pharmaceutical / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
D018501:Antirheumatic Agents; D001688:Biological Products
Biologics; Cost; Psoriasis; Rheumatic conditions