Persistence, switch rates, drug consumption and costs of biological treatment of rheumatoid arthritis: an observational study in Italy

Abstract

ObjectivesThe aim of this analysis was to provide an estimate of drug utilization indicators (persistence, switch rate and drug consumption) on biologics and the corresponding costs (drugs, admissions and specialist care) incurred by the Italian National Health Service in the management of adult patients with rheumatoid arthritis (RA).MethodsWe conducted an observational retrospective cohort analysis using the administrative databases of three local health units. We considered all patients aged ≥18 years with a diagnosis of RA and at least one biologic drug prescription between January 2010 and December 2012 (recruitment period). Persistence was defined as maintenance over the last 3 months of the follow-up period of the same biological therapy administered at the index date. A switch was defined as the presence of a biological therapy other than that administered at the index date during the last 3 months of the follow-up period. Hospital admissions (with a diagnosis of RA or other RA-related diagnoses), specialist outpatient services, instrumental diagnostics and pharmaceutical consumption were assessed.ResultsThe drug utilization analysis took into account only biologics with at least 90 patients on treatment at baseline (adalimumab n=144, etanercept n=236 and infliximab n=94). In each year, etanercept showed better persistence with initial treatment than adalimumab or infliximab. Etanercept was characterized by the lowest number of patients increasing the initial drug consumption (2.6%) and by the highest number of patients reducing the initial drug consumption (10.5%). The mean cost of treatment for a patient persisting with the initial treatment was €12,388 (€14,182 for adalimumab, €12,103 for etanercept and €11,002 for infliximab). The treatment costs for patients switching from initial treatment during the first year of follow-up were higher than for patients who did not switch (€12,710 vs. €11,332).ConclusionPersistence, switch rate and drug consumption seem to directly influence treatment costs. In subjects not persisting with initial treatment, other health care costs were approximately three times higher than for persistent patients. This difference could suggest a positive effect on the quality of life for persistent patients. Etanercept showed the highest persistence with treatment.

Long-Term Effectiveness of Adalimumab in Patients with Rheumatoid Arthritis: An Observational Analysis from the Corrona Rheumatoid Arthritis Registry

“…Similar observational results focusing on long-term effectiveness have been reported in the literature reporting persistence between 22% and 41% by 3 years, but these studies did not observe patients for the length of time ours did [35,36]. A multitude of other observational and registry derived data are available which either followed patients for fewer years [37] or had followed considerably fewer patients [38].…”

A Targeted Literature Review Examining Biologic Therapy Compliance and Persistence in Chronic Inflammatory Diseases to Identify the Associated Unmet Needs, Driving Factors, and Consequences

“…When comparing switching to another TNFi as opposed to switching out of class, all-cause costs were higher in patients switching to a non-TNFi biologic DMARD compared with an alternative biologic TNFi [ 84 ]. Overall, RA patients with high rates of persistence (> 80%) had higher total healthcare costs, driven by higher pharmacy costs; however, the total non-pharmacy costs, including in- and outpatient visits and laboratory services, were lower than costs reported for patients with persistence rates of < 80% (Table 5 ) [ 85 , 86 ].…”

“…The review also identified papers showing that patients who cycle through multiple biologic therapies incur higher costs and become less responsive to treatment [ 84 , 86 ]. Therefore, in the context of chronic diseases, it is beneficial to both individual patients and health systems to optimize patient journeys to ensure patients can cope with their treatment and remain compliant and persistent so as to avoid frequent cycling of multiple treatment options.…”

Auswahl klinischer und diagnostischer Ergebnisse bei entzündlichen Gelenkerkrankungen

“…Die Kostenfrage von Therapiemodalitäten tritt zunehmend in den Vordergrund der Diskussionen und fließen in die Empfehlungen ein [3,6,[10][11][12][13][14][15]. Diese Notwendigkeit erschließt sich über die Zulassung v. a. hochpreisiger spezifischer Medikamentenentwicklungen der letzten zwei Jahrzehnte.…”