title: Comparing Biologic Cost Per Treated Patient Across Indications Among Adult US Managed Care Patients: A Retrospective Cohort Study.
abstract: BACKGROUND
  The relative cost of biologics in the treatment of autoimmune disorders, including rheumatoid arthritis, psoriatic arthritis, psoriasis, and ankylosing spondylitis, is a key consideration for managed care payers.
  
  
  OBJECTIVE
  Our objective was to estimate biologic costs and treatment patterns in US managed care patients with rheumatoid arthritis, psoriatic arthritis, psoriasis, and/or ankylosing spondylitis.
  
  
  METHODS
  This retrospective study used administrative claims data from the HealthCore Integrated Research Database (HIRDSM) for adults with rheumatoid arthritis, psoriatic arthritis, psoriasis, and/or ankylosing spondylitis who received abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab, or ustekinumab between 1 July 2009 and 31 January 2013. Biologic costs (based on drug utilization) and treatment patterns (discontinued, restarted after a >45-day gap, switched to another biologic, or persisted without switching or stopping) were analyzed for the first year post-index.
  
  
  RESULTS
  Most of the 24,460 patients received etanercept (48 %), adalimumab (29 %), or infliximab (12 %) as the index biologic. On the index date, 44 % were new to biologic therapy and 56 % were continuing biologic therapy. Biologic cost per treated patient for 1 year was as follows: etanercept $US24,859, adalimumab $US26,537, and infliximab $US26,468. Treatment patterns across indications for etanercept, adalimumab, and infliximab were as follows: persistent (52, 49, 67 %), restarted (23, 21, 12 %), switched (12, 13, 11 %), and discontinued (14, 18, 10 %).
  
  
  CONCLUSIONS
  These findings from a large health benefits organization in the USA are similar to those of several previous cost analyses assessing different populations, which demonstrates the external validity of the results from the previous studies, both over time and across large populations.
authors.affiliation: HealthCore, Inc., 123 S. Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA. TGu@healthcore.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Gu
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Shah
authors.affiliation: HealthCore, Inc., 123 S. Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Deshpande
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Derek H
authors.initials: DH
authors.lastname: Tang
authors.affiliation: HealthCore, Inc., 123 S. Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA.
authors.forename: Debra F
authors.initials: DF
authors.lastname: Eisenberg