Estimating effectiveness and cost of biologics for XXXX : application of a validated algorithm to commercial insurance claims.

@entity1 @entity309
PURPOSE: The aim of this analysis was to implement a claims-based algorithm to estimate biologic cost per effectively treated @entity1 for biologics approved for moderate to severe @entity309 ( @entity309 ). METHODS: This retrospective analysis included commercially insured adults (aged 18-63 years) with @entity309 in a commercial database, who initiated biologic treatment with abatacept, adalimumab, etanercept, golimumab, or infliximab between 2007 and 2010. The algorithm defined effectiveness as having all of the following: high adherence, no biologic dose increase, no biologic switching, no new nonbiologic disease-modifying antirheumatic drug, no increased or new oral glucocorticoid use, and no more than 1 glucocorticoid injection. For each biologic, cost per effectively treated @entity1 was defined as total drug and administration costs (from allowed amounts on claims), divided by the number of @entity1 categorized as effectively treated. FINDINGS: Of 15,351 @entity1 , 12,018 (78.3%) were @entity1 , and the mean (SD) age was 49.7 (9.6) years. The algorithm categorized treatment as effective in the first year for 30% (1899/6374) of etanercept, 30% (1396/4661) of adalimumab, 20% (560/2765) of infliximab, 27% (361/1338) of abatacept, and 29% (62/213) of golimumab treated @entity1 . The 1-year biologic cost per effectively treated @entity1 , as defined by the algorithm, was nominally lower for subcutaneously injected biologics than for infused biologics. The 1-year biologic cost per effectively treated @entity1 , as defined by the algorithm, was lowest for etanercept ( 49,952), followed by golimumab ( 50,189), adalimumab ( 52,858), abatacept ( 71,866), and infliximab ( 104,333). IMPLICATIONS: Algorithm-defined effectiveness was similar for biologics other than infliximab. The 1-year biologic cost per effectively treated @entity1 , as defined by the algorithm, was nominally lower for subcutaneously injected biologics than for infused biologics.
