title: Analysis and Breakdown of Overall 1-Year Costs Relative to Inpatient and Outpatient Care Among Rheumatoid Arthritis Patients Treated with Biotherapies Using Health Insurance Claims Database in Alsace.
abstract: BACKGROUND
  The economic burden linked to rheumatoid arthritis (RA) has greatly increased since the inclusion of biotherapies in the therapeutic arsenal.
  
  
  OBJECTIVE
  This study aimed first to look at the breakdown of the rheumatoid arthritis patients on biotherapy in Alsace, France, in 2012, then to evaluate the annual cost per treated patient for each management pathway: inpatient care with intravenous biotherapies and/or outpatient care through the use of subcutaneous drugs, and finally to conduct a cost comparison with a focus on infliximab, adalimumab and etanercept.
  
  
  METHODS
  This observational study was conducted in Alsace using 2012 health claims data from the DCIR (Données de Consommation Inter Régime) and PMSI (Programme de Médicalisation des Systèmes d'Information) databases, taking into account direct medical and non-medical costs in a real-life setting and from a National Health Insurance perspective.
  
  
  RESULTS
  There were 5702 RA patients, i.e. 0.31 % of the Alsace population in 2012, including 1075 subjects (18.85 %) receiving biotherapy treatment. The most frequently prescribed biotherapies were etanercept and adalimumab. The estimated overall cost of care of these 5702 patients was €30.3 million, with about 50 % for the care of the 18.85 % patients on biotherapy. Average costs for inpatient, outpatient and mixed care ranged from €14,197 to €16,873 per patient per year. Annual average cost for management of a single RA patient with infliximab was significantly higher than with adalimumab and etanercept: €16,480 versus €14,116 and €14,338, respectively.
  
  
  CONCLUSIONS
  These findings confirm the trends of initial modelling approaches and quantify the cost difference between various biotherapy management pathways.
authors.affiliation: Laboratoire d'épidémiologie et de santé publique-EA 3430, Faculté de Médecine, Université de Strasbourg, 67085, Strasbourg Cedex, France. morganebeck68@gmail.com.|OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 14, rue du Maréchal Juin, 67084, Strasbourg Cedex, France. morganebeck68@gmail.com.
authors.forename: Morgane
authors.initials: M
authors.lastname: Beck
authors.affiliation: Laboratoire d'épidémiologie et de santé publique-EA 3430, Faculté de Médecine, Université de Strasbourg, 67085, Strasbourg Cedex, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
authors.affiliation: OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 14, rue du Maréchal Juin, 67084, Strasbourg Cedex, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Rybarczyk-Vigouret
authors.affiliation: Direction Régionale du Service Médical d'Alsace-Moselle, 67003, Strasbourg Cedex, France.
authors.forename: José
authors.initials: J
authors.lastname: Covassin
authors.affiliation: Service de rhumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67098, Strasbourg Cedex, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Sordet
authors.affiliation: OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 14, rue du Maréchal Juin, 67084, Strasbourg Cedex, France.|Service de Pharmacie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Laboratoire HuManiS-EA 7308, Faculté de Pharmacie, Université de Strasbourg, 67098, Strasbourg Cedex, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Michel