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The American Journal of Managed Care Special Issue: Pharmacy Benefits
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Cost of Biologic Treatment Persistence or Switching in Rheumatoid Arthritis

Tao Gu, PhD; Alex Mutebi, PhD; Bradley S. Stolshek, PharmD; and Hiangkiat Tan, MS, BSPharm
Patients with rheumatoid arthritis who switched biologics incurred higher costs than patients who persisted on biologics. Etanercept appeared to be associated with the lowest costs.
ABSTRACT

Objectives: To estimate total costs among patients with rheumatoid arthritis (RA) who persisted on or switched from newly initiated biologic therapy.

Study Design: A retrospective claims database analysis.

Methods: This analysis included adults in the HealthCore Integrated Research Database with RA who initiated treatment with a biologic for RA (abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, or tocilizumab) between January 2009 and November 2014. Total healthcare costs (plan- and patient-paid) were estimated for 1 year post index. Treatment persistence was defined as no discontinuation (ie, no refill gap >45 days) and no biologic switch.

Results: Of 7468 patients, 45.2% persisted on the index biologic for at least 1 year without a refill gap and 16.7% switched to another biologic in the first year; other patients discontinued the index biologic (23.2%) or restarted after a refill gap (15.0%). Mean 1-year total healthcare costs per patient were $41,901 (95% CI, $40,855-$42,947) among persistent patients and $44,244 (95% CI, $40,820-$47,668) among switchers. In a multivariable analysis of all patients, switchers had 5% higher postindex costs on average than persistent patients (exp(β) = 1.05; 95% CI, 1.01-1.08), and etanercept had the lowest postindex costs (exp(β) ranged from 1.03 to 1.51 for other biologics relative to etanercept).

Conclusions: Patients with RA who switched biologic therapy incurred higher 1-year total postswitch healthcare costs compared with patients who were persistent on the index biologic. Healthcare costs were lowest for patients who started on etanercept, particularly those who persisted on etanercept.

Am J Manag Care. 2018;24(Spec Issue No. 8):SP338-SP345

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