Cost and Effectiveness of Biologics for XXXX in a Commercially Insured Population.

@entity1 @entity309
BACKGROUND: Administrative claims contain detailed medication, diagnosis, and procedure data, but the lack of clinical outcomes for @entity309 ( @entity309 ) historically has limited their use in comparative effectiveness research. A claims-based algorithm was developed and validated to estimate effectiveness for @entity309 from data for adherence, dosing, and treatment modifications. OBJECTIVE: To implement the claims-based algorithm in a U.S. managed care database to estimate biologic cost per effectively treated @entity1 . METHODS: The cohort included @entity1 with @entity309 aged 18-63 years in the Optum Research Database who initiated biologic treatment between January 2007 and December 2010 and were continuously enrolled 6 months before through 12 months after the first claim for the biologic (the index date). @entity1 were categorized as effectively treated by the claims-based algorithm if they met all of the following 6 criteria in the 12-month post-index period: (1) a medication possession ratio >=    80% for subcutaneous biologics, or at least as many infusions as specified in U.S. labeling for intravenous biologics; (2) no increase in biologic dose; (3) no switch in biologics; (4) no new nonbiologic disease-modifying antirheumatic drug; (5) no new or increased oral glucocorticoid treatment; and (6) no more than 1 glucocorticoid injection. Drug costs (all biologics) and administration costs (intravenous biologics) were obtained from allowed amounts on claims. Biologic cost per effectively treated @entity1 was defined as total 1-year biologic cost divided by the number of @entity1 categorized by the algorithm as effectively treated with that index biologic. Sensitivity analysis was conducted to examine the total health care costs per effectively treated @entity1 during the first year of biologic therapy. RESULTS: A total of 5,474 individuals were included in the analysis. The index biologic was categorized as effective by the algorithm for 28.9% of @entity1 overall, including 30.6% for subcutaneous biologics and 22.1% for intravenous biologics. The index biologic was categorized as effective in the first year for 32.7% of etanercept (794/2,425), 32.3% of golimumab (40/124), 30.2% of abatacept (89/295), 27.7% of adalimumab (514/1,857), and 19.0% of infliximab (147/773) @entity1 . Mean 1-year biologic cost per effectively treated @entity1 , as defined in the algorithm, was lowest for etanercept ( 43,935), followed by golimumab ( 49,589), adalimumab ( 52,752), abatacept ( 62,300), and infliximab ( 101,402). The rank order in the sensitivity analysis was the same, except for golimumab and etanercept.  CONCLUSIONS: Using a claims-based algorithm in a large commercial claims database, etanercept was the most effective and had the lowest biologic cost per effectively treated @entity1 with @entity309 .
