Abstract:
BACKGROUND:Costs associated with biologic switching and discontinuation can be high in chronic inflammatory diseases. Inappropriate use of medications may have cost implications for both payers and patients. Understanding of biologic utilization and switching rates is lacking among patients with ankylosing spondylitis (AS). OBJECTIVE:To compare direct costs of treatment switchers, nonswitchers, and discontinuers among patients with AS who newly initiated a biologic. METHODS:Patients aged ≥ 18 years with an AS diagnosis and ≥ 1 pharmacy claim for an FDA-approved subcutaneous biologic for AS between January 1, 2016, and December 31, 2016 (identification period) were identified from the Truven Health MarketScan Databases. At the time of biologic initiation (index date), eligible patients were continuously enrolled with medical and pharmacy claims for ≥ 1 year before (baseline period) and ≥ 1 year after the index date (follow-up period). Patients with AS were categorized into 3 mutually exclusive groups of nonswitchers (patients who remained on their index biologic), switchers (patients who had a prescription for a biologic therapy other than their index biologic), and discontinuers (patients who had gaps in prescription claims [> 120 days]) based on their biologic utilization pattern during the 1-year follow-up period. Health care costs (inflated to year 2017 costs) during follow-up were described across the 3 groups separately and by disease. Adjusted health care resource utilization and costs during 1-year follow-up were estimated, controlling for age, sex, fulltime work status, and Charlson Comorbidity Index (Deyo's modification) during the baseline period. RESULTS:A total of 791 patients with AS who were newly initiating a biologic were categorized as switchers (15.4%), nonswitchers (53.1%), and discontinuers (31.5%). Switchers and discontinuers had higher all-cause health care utilization than nonswitchers during the 1-year follow-up period. Switchers had higher mean total health care costs than nonswitchers ($71,280 vs. $66,573) due to increased medical ($13,897 vs. $12,043) and pharmacy costs ($57,384 vs. $54,530). Discontinuers had the lowest total health care costs ($41,179) but had the highest medical costs ($19,079). Adjusted analyses for covariates confirmed similar trends as the unadjusted analysis, where discontinuers had significantly lower total health care and pharmacy costs but had higher medical costs (with increased emergency department and outpatient visits) than nonswitchers (all P < 0.001). Switchers had increased outpatient visits and costs versus nonswitchers in the adjusted analysis (P < 0.001); small sample sizes in the switcher group may have limited the ability to detect significant trends in the adjusted analysis. CONCLUSIONS:Biologic switching resulted in higher total health care costs than remaining on the same biologic in patients with AS. These findings highlight the clinical and economic impact of discontinuing or switching biologic therapies in patients with AS, which may inform treatment and/or formulary decision making. DISCLOSURES:This study was sponsored by Novartis Pharmaceuticals (East Hanover, NJ). Yi, Dai, and Park are employed by Novartis. Piao was an employee of KMK Consulting, supporting Novartis at the time of this study; Zheng is an employee of KMK Consulting and works as a consultant for Novartis. Portions of this work were presented at the 2019 AMCP Managed Care and Specialty Pharmacy Annual Meeting; March 25-28, 2019; San Diego, CA; and AMCP Nexus 2019; October 29-November 1, 2019; National Harbor, MD.
journal_name
J Manag Care Spec Pharmjournal_title
Journal of managed care & specialty pharmacyauthors
Yi E,Dai D,Piao OW,Zheng JZ,Park Ydoi
10.18553/jmcp.2020.19433subject
Has Abstractpub_date
2021-01-01 00:00:00pages
27-36issue
1eissn
2376-0540issn
2376-1032journal_volume
27pub_type
杂志文章abstract:BACKGROUND:Adjuvant trastuzumab treatment is administered to early stage breast cancer patients in physician office (POV) or hospital outpatient (HOP) settings. OBJECTIVE:To identify treatment patterns, utilization, and costs by site of care (POV vs. HOP) of patients with adjuvant treatment of breast cancer with trast...
journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
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pub_type: 杂志文章,多中心研究
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
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journal_title:Journal of managed care & specialty pharmacy
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更新日期:2017-07-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.14251
更新日期:2016-02-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
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更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Allergic rhinitis (AR) is a common condition that can be treated with a number of different therapies. Treatments such as intranasal antihistamines (INAs) and intranasal steroids (INSs) are widely used by AR patients. For some allergy sufferers, a combination of therapies, specifically an INA and an INS, is ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.12.1426
更新日期:2016-12-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 共识发展会议,杂志文章
doi:10.18553/jmcp.2020.26.1.48
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Adherence to biologic disease-modifying antirheumatic drugs (bDMARDs) among patients with rheumatoid arthritis (RA) is often suboptimal in routine clinical practice. Low or nonadherence can reduce the effectiveness of bDMARD therapies. OBJECTIVE:To evaluate filling of newly prescribed initial bDMARDs for th...
journal_title:Journal of managed care & specialty pharmacy
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pub_type: 杂志文章
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.10.1054
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2018.24.2-a.s3
更新日期:2018-02-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.8.859
更新日期:2019-08-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.7.796
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pub_type: 杂志文章,多中心研究
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.7.669
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abstract:DISCLOSURES:No funding supported the writing of this article. The author has nothing to disclose. ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2020.26.5.592
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
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