Cost Of Adalimumab Research Articles

Effects of Adalimumab Entering National Reimbursement on Medical Costs for Patients With Psoriasis: A 4-Year Single-Center Retrospective Study in China

Objective: Adalimumab (ADA) is expensive and rarely used among patients. However, its cost for moderate to severe chronic plaque psoriasis can now be reimbursed since its addition to the National Reimbursement Drug List (NRDL) in January 2020. Therefore, we conducted this study to estimate the medical cost of ADA and its influencing factors in patients with psoriasis using ADA and thus gain a better understanding of the effect of the NRDL adjustment in China. Methods: This retrospective study evaluated the medical cost of ADA before and after the addition of ADA to the NRDL (2018—2022) among 320 patients in a large professional dermatology specialty hospital. Descriptive analysis, Welch’s analysis of variance, and multiple regression analysis were used to evaluate the medical cost and influencing factors. Results: Before ADA was added to the NRDL, patients’ mean total cost and ADA cost were ¥24,243.56 ± 16,346.53 and ¥20,391.11 ± 14,440.69, respectively. After ADA became covered by the NRDL, the above 2 expenses decreased to ¥10,461.19 ± 7,554.66 and ¥8,775.27 ± 7,092.16, respectively. This significant decrease in the cost of ADA resulted in a significant 110.5-times increase in ADA use. Statistically significant differences were found in the total cost, patient type (outpatient/inpatient), insurance status (yes/no), reimbursement status (before/after), and age. Medical insurance reimbursement (P < 0.001, β = -0.468, before reimbursement = 1, after reimbursement = 2) was the most significant influencing factor, followed by patient type (P = 0.018, β = -0.215, outpatient = 1, inpatient = 2) and age (P = 0.0046, β = -0.174). Conclusion: Medical insurance reimbursement is the most important factor affecting patients’ total cost of ADA by reducing the economic burden, enhancing the availability of ADA, and stimulating the need for treatment.

A204 COST-EFFECTIVENESS OF THERAPIES AFTER FAILURE OF CONVENTIONAL THERAPY FOR PATIENTS WITH MODERATE-TO-SEVERE ULCERATIVE COLITIS IN THE CANADIAN HEALTHCARE SYSTEM

Abstract Background Ulcerative colitis (UC) is a chronic inflammatory disease of the colon which requires ongoing medical therapy. The therapeutic options for moderate-to-severe UC include biologics and small molecules, which are effective but come with a significant cost. As such, their exact positioning in the therapeutic algorithm remains unclear. Purpose The aim of our study was to assess and compare the cost-effectiveness of infliximab, adalimumab, vedolizumab, golimumab, ustekinumab and tofacitinib for the management of moderate-to-severe UC from the perspective of the Canadian public healthcare system. Method A Markov model was constructed to simulate the disease course of UC patients after initiating each available therapy. Drug costs were obtained from the Alberta Health Drug Benefit List and the remaining costs were determined from the CIHI Patient Cost Estimator. Transition probabilities were obtained from a review of the literature, and loss of response and complication rates were obtained from randomized controlled trials. Our main analysis used a time horizon of 5 years, and time horizons of 1- and 10-years were also assessed in our sensitivity analysis. Probabilistic sensitivity analysis was performed to characterize uncertainty related to all parameters. Result(s) Infliximab costs $26,611 per quality-adjusted life year (QALY) using a 5-year time horizon. Adalimumab costs $20,783 per QALY. Vedolizumab costs $40,553 per QALY. Golimumab costs $34,316 per QALY. Ustekinumab costs $26,366 per QALY. Lastly, tofacitinib costs $25,572 per QALY. At a willingness-to-pay threshold of $50,000 per QALY, sensitivity analysis revealed that infliximab, adalimumab, vedolizumab, golimumab, ustekinumab and tofacitinib had a 36%, 12%, 1%, 1%, 44% and 6% probability of being cost-effective, respectively. Conclusion(s) Our economic model concluded that adalimumab is the most cost-effective first-line therapy for UC patients who have failed conventional therapy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

PSY100 - COST-EFFECTIVENESS ANALYSIS OF SECOND LINE TREATMENT FOR PATIENTS WITH ULCERATIVE COLITIS

To evaluate the incremental cost-effectiveness ratio (ICER) of infliximab versus adalimumab and golimumab for second line treatment in adult patients diagnosed with moderate to severe ulcerative colitis with inadequate response or refractory to treatment with immunomodulators, in the Chilean context. A cost-effectiveness analysis based on a Markov model and a literature review of mathematical models for the pathology was conducted to inform the model structure.The Markov model comprised five health states:1.moderate to severe ulcerative colitis; 2.mild ulcerative colitis; 3.post-surgery; 4.specific death and 5.other causes of death. The effectiveness was expressed in quality adjusted life years (QALY), while the costs were expressed in Chilean pesos (CLP) 2017. A public health payer perspective and an undifferentiated discount rate for costs and effects of 3% were adopted. A cohort from age 18 to Chilean life expectancy 80 years old, was modelled. A probabilistic sensitivity analysis was performed for utility values, costs, transition probabilities and discount rates within a range of 0 and 6%. The base case ICER for infliximab versus adalimumab was $59.751.286 CLP (USD 94.904) per quality adjusted life year (QALY) gained. Golimumab presented extended dominance. Only two parameters presented significant uncertainty:discount rate and cost of adalimumab, however it does not change the results. Infliximab delivers more QALYs than adalimumab and golimumab, but it is not a cost-effective option. The ICER is above the cost-effectiveness threshold of 1 gross domestic product (GDP) per capita for 2017 in Chile. More long-term effectiveness studies are need it in order to decrease uncertainty of the Markov model results.

PTU-069 Effect of Adalimumab on Patients with Moderate to Severe Ulcerative Colitis in UK Clinical Practice Setting: Results from Inspirada

Introduction Limited real world data are available regarding the effects of adalimumab (ADA) on UK patients with moderate to severe ulcerative colitis (UC). Methods INSPIRADA was a single-arm, multi-country, open-label study that evaluated the effect of ADA on patients with UC treated according to usual clinical practice. Adults with active moderate to severe UC who failed immunosuppressive therapies and experienced rectal bleeding within 7 days of baseline (BL) were enrolled. Prior use of anti-TNF was allowed. Clinical outcomes included Simple Clinical Colitis Activity Index (SCCAI) response (a decrease ≥2 points compared to BL) and remission (SCCAI ≤2). HRQoL (EQ-5D-5L and SIBDQ), treatment satisfaction with medication (TSQM), and work productivity and activity impairment (WPAI) were measured from BL to week 26. Direct medical costs (excluding ADA costs) were estimated using 2014 UK National Health Service reference costs. Indirect costs were based on the WPAI using average weekly earnings from the 2014 UK Annual Salary Survey of Hours and Earnings. Change (defined as 6 mo after start of ADA vs 6 mo before) in resource use and costs were calculated. Data for the intent-to-treat population in UK were analysed. Missing data were imputed using last observation carried forward. Results Data from 90 UK patients (58% male, mean age 39 yrs) were analysed. Mean SCCAI at BL was 8.2. At week 2, 74% achieved SCCAI response and 21% achieved SCCAI remission. At week 8, 73% achieved SCCAI response, 40% in remission and 49% had no blood in stool. At week 26, 66% achieved SCCAI response, 42% in remission and 51% had no blood in stool. Significant improvements, as early as within 2 weeks, in SIBDQ (19.5 points, p Conclusion Real world rates of response, remission and improvements in HRQoL with ADA for UK patients with moderate to severe UC were clinically meaningful. ADA improved work productivity, increased patient satisfaction with therapy and reduced health care associated costs for these patients in the UK. Disclosure of Interest P. Irving Grant/research support from: AbbVie; Falk; Ferring; Genentech/Roche; Hospira; Merck; Pharmacosmos; Shire; Takeda; Tillotts; Topivert; Vifor and Warner Chilcott, Conflict with: Advisor/invited lecturer for: AbbVie; Falk; Ferring; Genentech/Roche; Hospira; Merck; Pharmacosmos; Shire; Takeda; Tillotts; Topivert; Vifor and Warner Chilcott, F. Cummings Conflict with: Advisor/lectures for: Takeda, Abbvie, MSD, Biogen, Napp, Hospira, Janssen, S. Bloom Conflict with: Advisor/lectures for: Takeda, Tillotts, Abbvie, MSD, Pharmacosmos, Vifor, Johnson and Johnson, A. Lazar Shareholder of: AbbVie, Employee of: AbbVie, A. Robinson Shareholder of: AbbVie, Employee of: AbbVie, B. Pappalardo Shareholder of: AbbVie, Employee of: AbbVie, M. Bereswill Shareholder of: AbbVie, Employee of: AbbVie, M. Skup Shareholder of: AbbVie, Employee of: AbbVie, N. Chen Shareholder of: AbbVie, Employee of: AbbVie, T. Finney-Hayward Shareholder of: AbbVie, Employee of: AbbVie, S. Wang Shareholder of: AbbVie, Employee of: AbbVie, R. Thakkar Shareholder of: AbbVie, Employee of: AbbVie, S. Travis Grant/research support from: AbbVie; Asahi; Boehringer Ingelheim; BMS; Cosmo; Elan; Ferring; FPRT Bio; Genentech/Roche; Genzyme; Glenmark; GW Pharmaceuticals; Lilly; Merck; Novartis; Novo Nordisk; Ocera; Pfizer; Shire; Santarus; SigmoidPharma; Synthon; Takeda; Tillotts; Topivert; Trino Therapeutics with Wellcome Trust; UCB Pharma; Vertex; VHsquared; Vifor; Warner Chilcott and Zeria, Conflict with: Advisor or paid instructor for: AbbVie; Asahi; Boehringer Ingelheim; BMS; Cosmo; Elan; Ferring; FPRT Bio; Genentech/Roche; Genzyme; Glenmark; GW Pharmaceuticals; Lilly; Merck; Novartis; Novo Nordisk; Ocera; Pfizer; Shire; Santarus; SigmoidPharma; Synthon; Takeda; Tillotts; Topivert; Trino Therapeutics with Wellcome Trust; UCB Pharma; Vertex; VHsquared; Vifor; Warner Chilcott and Zeria. All advisory boards were suspended Q1 2012–14 while President of ECCO

An observational study of the real-life management of psoriasis patients treated with etanercept according to the new reimbursement criteria (in Belgium)

Background: This study described the number of patients with psoriasis receiving flexible (continuous/intermittent) dosing with etanercept (ETN) and the real-world economic impact. Methods: BeFlex was a prospective, observational study with a ≥1 year follow-up. Patients ≥18 years with moderate-to-severe psoriasis who were starting or re-starting treatment with ETN in alignment with Belgian reimbursement criteria were included. Cost of ETN was compared with cost of adalimumab, ustekinumab and infliximab using estimates from the National Institute for Sickness and Disability Insurance (INAMI/RIZIV). Results: In the flexible-dosing cohort (n = 121 with dose-regimen data), 66% were treated continuously and 34% intermittently. Baseline characteristics were similar across dosing cohorts. In the per-protocol cohort (n = 138), average ETN treatment duration/year was 40 weeks; 43 weeks continuous and 33 weeks intermittent. The overall mean interruption duration was 3.9 weeks/treatment cycle; 0.2 week continuous and 11.1 weeks intermittent. Mean dose/year was 2065 mg; 2182 mg continuous and 1660 mg intermittent. Flexible ETN dosing reduced the cost by 20% versus INAMI/RIZIV estimates. The theoretical cost of the other continuously-dosed biologics was 28–44% higher than that of flexible ETN. Conclusion: Approximately one-third of Belgian patients received intermittent ETN treatment. Flexible ETN dosing was more cost-effective than treatment with biologic agents that require continuous dosing.

AB0414 Claims Database Analysis of Adherence to Adalimumab Therapy and Health Care Costs for Patients with Rheumatoid Arthritis

BackgroundWe examined the relationship between adherence to adalimumab (ADA), an injectable tumor necrosis factor alpha inhibitor, and health care costs for patients with rheumatoid arthritis (RA).MethodsAdult patients (≥18 years old)...

PMS17 Cost Minimization of Anti-TNF Biologics in the Treatment of Rheumatoid Arthritis, Akylosing Spondylitis and Psoriatic Arthritis in the Brazilian Public Health Care System

To compare treatment costs of all anti-TNFa biologics treatments in rheumatoid arthritis (RA), akylkosing spondilitis (AS) and psoriatic arthristis (PsA) in the Brazilian public health care system. In Brazil, four anti-TNFa biologics are available for the treatment of RA, AS and PsA: adalimumab, etanercept, infliximab, and golimumab. Yearly treatment costs were calculated for an average patient of 70 kgs, considering dose and dosing intervals as defined in the label for each drug. The price for adalimumab, etanercept and infliximab was gathered from the official government website for centralized purchasing, as these drugs are already reimbursed for the three indications. The price of golimumab was defined according to law, based on the mandatory government discount of 24,38% over the official list price. Golimumab has the lowest treatment cost across the biologics in all indications, at R$ 21,471.94 per patient per year. This treatment cost does not vary across indications or across years of treatment, as it does not include a higher initial dose. Infliximab has the second lowest treatment followed by adalimumabe at a cost of R$ 29,280.00 and R$ 36,374.00 per patient respectively. Due to higher dosing of infliximab for AS and PsA, the average cost per patient is R$ 37,820.00 similar to the yearly cost of adalimumab. Etanercept has the highest treatment cost across all indications at R$ 44,800 per patient per year, with the highest number of vials per patient per year. With the lowest treatment cost, golimumab is an important treatment option for RA, AS and PsA. Given the high expenditure of the Brazilian government with anti-TNFs, golimumabe can decrease government expenditure between 27%-50%. Considering the total health care expenditure of R$ 1.67 million with adalimumab, etanercept and infliximab in the last 12 months, golimumab has the cost saving potential of about R$ 449 million.

Rectification of miscalculation of adalimumab costs

Response to: Eshuis EJ, Stokkers PC, Bemelman WA. Decision-making in ileocecal Crohn’s disease management: surgery versus pharmacotherapy. Expert Rev. Gastroenterol. Hepatol. 4(2), 181–189 (2010).

Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries.

SummaryBackgroundThe aim of this study was to assess and compare patients’ access to biologic anti-RA drugs in selected Central and Eastern European (CEE) countries and to analyze the determinants of differences between countries.Material/MethodsThis is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using an affordability index, calculated comparing the index of health care expenditures to the price index, using Poland as an index of 1.ResultsThe percentage of patients on biologic treatment in 2009 was highest in Hungary (5% RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), Czech Republic (2.92%), Romania (2.2%), Estonia (1.8%), and Croatia, Serbia, Poland (below 1.5%). Infliximab, etanercept, adalimumab and rituximab were included in the reimbursement system in all countries, but abatacept and tocilizumab were included only in Slovakia. In Slovenia, public payer covered 75% of the price, and 25% is covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries, biologic drugs are reimbursed at 100%. Affordability index for biologic drugs was the lowest in Slovenia (0.4). In each country national guidelines define which patients are eligible for biologic treatment. Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.ConclusionsThe most important factors limiting access to biologic anti-RA treatment in the CEE region are macroeconomic conditions and restrictive treatment guidelines.

Cost-Effectiveness of Sequential Therapy with Tumor Necrosis Factor Antagonists in Early Rheumatoid Arthritis

To estimate the comparative lifetime cost-effectiveness of sequenced therapy with tumor necrosis factor (TNF) antagonists as the initial therapeutic intervention for patients with early rheumatoid arthritis (RA). Because patients with RA switch regimens many times throughout the course of disease, sequenced therapeutic interventions were modeled, continuing until the last effective agent failed or death occurred. The model used published clinical outcomes from short-term, randomized controlled trials. Direct treatment costs and costs of lost productivity were modeled for each of 5 alternative treatment sequences. Incremental cost-effectiveness ratios are expressed as quality-adjusted lifeyears (QALY) gained. Treatment sequences that included TNF antagonists produced a greater number of QALY than conventional disease modifying antirheumatic drug regimens alone. The cost-effectiveness of sequenced therapy initiated with adalimumab plus methotrexate (MTX) extendedly dominated both infliximab-plus-MTX-initiated and etanercept sequences. The cost of adalimumab plus MTX per QALY was US $47,157 excluding productivity losses, and $19,663 including productivity losses. A supplementary sequence that incorporated adalimumab-plus-MTX-initiated first-line therapy followed by another TNF antagonist as second-line therapy was modeled; this sequence resulted in additional QALY gained and extendedly dominated all single-TNF strategies. Of the 3 single-TNF antagonist sequences, the adalimumab-plus-MTX-initiated sequence was cost-effective in producing the greatest number of QALY. Multiple TNF strategies, such as the supplementary sequence modeled in this analysis, may be cost-effective in producing even greater health gain.

Adalimumab Maintenance Therapy Is Cost Effective for Maintaining Remission in Patients with Crohnʼs Disease

Purpose: Adalimumab, a fully human monoclonal antibody targeting tumor necrosis factor, is approved for treatment of adults with moderate severe Crohn's disease (CD). CLASSIC I and CHARM are two Phase III studies of the effectiveness of adalimumab in inducing and maintaining remission, respectively, in patients with moderate to severe CD. Methods: The objective of this analysis was to evaluate the cost-effectiveness of adalimumab compared to nonbiologic therapies in the maintenance treatment of CD. A cost-utility model compared these strategies from the perspective of the UK National Health Service over 1-year and lifetime horizons. Patients were modeled in four disease states based on their Crohn's Disease Activity Index (CDAI) scores. CHARM data were directly used to estimate adalimumab arm efficacy. A regression model using CLASSIC I data was used to similarly predict the CDAI state of patients who received standard of care. Hospitalizations for both arms were modeled using the clinical trials data. Utilization of other medical resources was based on CDAI states. The cost of adalimumab was £357.50 per 40 mg vial, and the cost of standard care drugs was assumed to be zero. Costs of hospitalization and other medical resources were taken from Bassi et al., 2004. All costs were inflated to 2006 British Pounds (GBP) based on the annual UK health price index. Health utility inputs were sourced from Gregor et al., 1997. Univariate and probabilistic sensitivity analyses were conducted. Results: Compared with nonbiologic therapy, adalimumab appeared to be cost-effective in the treatment of patients with both severe CD and moderate to severe CD, with a 56-week incremental cost effectiveness ratio (ICER) of £16,064/quality-adjusted life-year (QALY) and £33,731/QALY, respectively. Sensitivity analyses demonstrated that the findings were robust. In the treatment of patients over their lifetimes, the ICERs were £5,479/QALY for patients with severe CD and £16,065/QALY for patients with moderate to severe CD. Sensitivity analyses demonstrated the robustness of the base case analysis. Conclusion: Adalimumab maintenance therapy for CD was cost-effective when compared to conventional nonbiological management. This research was funded by Abbott Laboratories, Abbott Park, IL.