FRI0528 Using a validated algorithm to evaluate the effectiveness and cost per effectively treated patient for biologics for rheumatoid arthritis (RA) in patients with employer provided health insurance
Authors: J. R. Curtis, V. F. Schabert, J. Yeaw, J. R. Korn, C. Quach, D. J. Harrison, H. Yun, G. J. Joseph, D. H. Collier
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Administrative claims contain detailed medication, diagnosis, and procedure data, but their lack of clinical outcomes for RA has limited their use in comparative effectiveness research. A validated claims-based algorithm uses a combination of adherence, dosing, and treatment modifications to estimate biologics' clinical effectiveness as proxies for low disease or remission for RA.<sup>1</sup> In the validation study, "effectiveness" was defined as reaching DAS 28 low disease activity or remission one year after initiating treatment. <h3>Objectives</h3> To implement this algorithm in a US managed-care database and calculate the cost per effectively treated patient among biologics approved for moderate to severe RA (etanercept, adalimumab, infliximab, golimumab, and abatacept). <h3>Methods</h3> Data were obtained from the commercially insured cohort in the Truven Marketscan Database. The cohort included patients with RA aged 18-63, initiating treatment between January 2007 and December 2010, without biologics 6 months before their first (index) treatment in the database, and continuously enrolled 6 months before and 12 months after their index biologic. Other disease indications for TNF therapy were excluded. The algorithm defines lack of effectiveness as: medication possession ratio &lt; 80% (or fewer infusions/injections than specified on US label), increase in biologic dose or frequency interval, switching biologics, adding new non-biologic Disease Modifying Anti-Rheumatic Drugs, glucocorticoid, dose increase or initiation, or more than one parenteral or intra-articular glucocorticoid injection during follow-up. Drug and administration costs were obtained from allowed amounts on claims. Cost per effectively treated patient was calculated as total drug cost for all patients initiating treatment on a given agent divided by the number of patients in whom that agent was classified as "effective" by the algorithm. <h3>Results</h3> The cohort included 15,351 patients, with a mean age of 49.7 (SD 9.5) years and 78.3% were female. Algorithm effectiveness criteria were met in 30% of etanercept (n=6,374), 30% of adalimumab (n=4,661), 20% of infliximab (n=2,765), 27% of abatacept (n=1,338), and 29% of golimumab (n=213) patients in the first 12 months of treatment. Mean first year cost per "effectively treated patient" was lowest for etanercept ($49,952), followed by golimumab ($50,189), adalimumab ($52,858), abatacept ($71,866), and infliximab ($104,333). <h3>Conclusions</h3> Algorithm-defined effectiveness was similar for all agents other than infliximab. Cost per "effectively treated patient" was lower for self-injected than infused biologics using a new, validated claims-based algorithm. <h3>References</h3> Curtis JR. et al. Derivation and preliminary validation of an administrative claims-based algorithm for the effectiveness of medications for rheumatoid arthritis. <i>Arthritis Res Ther.</i> 13:R155, 2011 <h3>Acknowledgements</h3> Research funded by Immunex Corporation, a wholly owned subsidiary of Amgen Inc., and by Wyeth, which was acquired by Pfizer Inc. in October 2009. <h3>Disclosure of Interest</h3> J. Curtis Grant/research support from: Roche/Genentech, UCB, Centocor, CORRONA, Amgen, Pfizer BMS, Janssen, AbbVie, V. Schabert: None Declared, J. Yeaw: None Declared, J. Korn: None Declared, C. Quach Consultant for: Amgen, Inc., D. Harrison Shareholder of: Amgen Inc., Employee of: Amgen, Inc., H. Yun: None Declared, G. Joseph Shareholder of: Amgen, Inc., Pfizer Inc., Employee of: Amgen, Inc., D. Collier Shareholder of: Amgen, Inc., Employee of: Amgen, Inc.