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Treatment with Biological Agents Among Patients with Ankylosing Spondylitis in Germany: A Claims Data Analysis
A532
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
modelled as an explanatory variable against the binary early retirement outcome, and adjusted for covariates including age, gender and BMI. Results: Adequate model fit determined. An odds ratio (OR) of 1.043 (p-value < 0.00) and average marginal effect of 0.6% (p-value < 0.00) per year of disease duration were calculated. The marginal effect was non-linear, increasing yearly with confounders held constant. The predicted probability for a patient to have retired due to RA after disease duration 1-5, 6-10 and > 10 years was 13.5%, 15.9% and 21.5% respectively. The likelihood that a patient had stopped working or retired early due to RA in the first 1-5 years of the disease increased across levels of current disease activity, with 5%, 9% and 15% across ‘remission’, ‘mild/moderate’ and ‘severe’ categories respectively. A ‘moderate/severe’ level of pain attributable to RA was found in 19% of patients in remission. Conclusions: Analysis suggests both disease duration and severity have an impact on the likelihood for a patient to retire early/stop working due to their RA. PMS33 The Impact of Disease Duration and Disease Activity on the Cost of Rheumatoid Arthritis: Results from Burden of Rheumatoid Arthritis Across Europe a Socioeconomic Survey (BRASS) Capron J1, De Leonardis F1, Fakhouri W1, Burke T2, Rose A2, Jacob I3 1Eli Lilly & Company, Indianapolis, IN, USA, 2HCD Economics, Warrington, UK, 3HCD Economics, Daresbury, UK
Objectives: Investigate the association between Disease Activity Score 28 C-Reactive Protein (DAS28-CRP) score, disease duration and patient costs in rheumatoid arthritis (RA) patients, using data from the Burden of Rheumatoid Arthritis across Europe: a Socioeconomic Survey (BRASS). Methods: Data were extracted from BRASS, a societal perspective observational RA dataset across 10 European countries (EU5, Denmark, Sweden, Hungary, Poland and Romania). 476 RA specialising clinicians provided information on 4,079 adult patients; of these, 2,087 patients completed corresponding questionnaires about the burden of RA. Twelve-month costs captured included: consultations, testing, hospital admissions and procedures, payments to professional caregivers, travel costs, requirement for aids/equipment and informal care costs. Indirect costs captured from the patient included work productivity impact. A generalised linear model was developed to investigate the association between disease duration, most recent DAS28-CRP score and total cost of patients excluding costs of conventional synthetic and biologic disease modifying drugs. Disease duration and DAS28-CRP score were modelled as explanatory variables against the total cost response variable, adjusted for covariates including age, gender and BMI. Results: The model provided adequate fit, uncertainty from between-country unit cost differences was investigated, and association between the variables of interest remained. The average marginal effect at the mean was calculated from regression outputs. Both disease duration and DAS28-CRP score had a statistically significant association with total cost; a unit increase in DAS28 score meant a total cost increase of € 1,075 (p= 0.004), whereas a unit increase in disease duration of one year increased total cost by € 360 (p= 0.012), with confounders age, gender, BMI and either DAS28-CRP or duration held at mean values. Descriptive analysis indicated that with greater duration of disease and/or disease activity, healthcare costs incurred outweigh treatment costs. Conclusions: Analysis suggests that disease duration and disease activity have a significant impact on total patient cost. PMS34 A Claims Data Analysis of Biological Agents for Psoriatic Arthritis In Germany Vollmer L1, Schleich W1, Rex J2, Walzer S1 1MArS- Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Elsevier Health Analytics, Berlin, Germany
Objectives: Approximately a third of patients with Psoriasis are developing Psoriatic arthritis (PsA). This study provides information on the current supply with biological agents and its related costs in Germany. Methods: A retrospective claims data analysis was conducted utilizing the Institute for Applied Health Research (InGef) Berlin, formerly HRI Health Risk Institute, database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances in Germany. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patient data from 2012 - 2016 were included if they met the following conditions: Main diagnosis of PsA (ICD-10 code L40.5), and start / maintenance / switch of treatment with PsA approved biological agent(s) (at least for three months). The study evaluated hospitalization, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: The level of share of prescriptions of all biological agents considered is low. Adalimumab and etanercept are administered mostly to patients already on treatment (in 2015 adalimumab 38.3 % vs. etanercept 31.3 %). Total costs of the included 1’545 patients add up to € 27’612’238 in 2015. The total number of patients, the number of hospitalizations and the total treatment costs including three out of four cost items grew yearly on average between 9.8 % and 13.1 % (2012 – 2015). The costs of other medication dropped yearly on average by 2.8 %. Average hospitalization per patient remained constant (0.6). Conclusions: Adalimumab and etanercept are those biological agents mainly used by patients already on treatment. Costs grew steadily over the last 4 years. Total costs in 2015 were € 27.6 million (on average € 17’872 per patient). PMS35 Treatment with Biological Agents Among Patients with Ankylosing Spondylitis in Germany: A Claims Data Analysis Schleich W1, Rex J2, Vollmer L1, Walzer S1 Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Elsevier Health Analytics, Berlin, Germany
1MArS-
Objectives: Over the past 15 years, the availability of anti-tumor necrosis factor inhibitors has altered the treatment approach of ankylosing spondylitis (AS). This
study provides information on the current supply with biological agents and its related costs. Methods: A retrospective claims data analysis was conducted utilizing the Institute for Applied Health Research (InGef) Berlin, formerly HRI Health Risk Institute, database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances in Germany. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patient data from 2012-2016 were included if they met following conditions: Main diagnosis of AS (ICD-10 code M45.-), and start / maintenance / switch treatment with AS approved biological agent(s) (at least for three months). The study evaluated hospital admission, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: Leading biological agents for 1st line treatment are adalimumab and etanercept at a low level of share of prescriptions. Both agents are administered mostly to patients already on treatment (in 2015 adalimumab 42.1 % vs. etanercept 30.0 %). Total costs of the included 1’342 patients add up to € 22’536’535 in 2015. Total number of patients, number of hospitalizations and total treatment costs including all individual cost items (costs of biological agents / other medication/ outpatient care / hospitalizations) grew yearly on average between 5.4 % and 11.1 % (2012 – 2015). Average hospitalization per patient remained constant at 0.6. Conclusions: Adalimumab and etanercept are those biological agents mainly used for treating AS. Costs grew steadily over the last four years. Total costs in 2015 were € 22.5 million (on average € 16’793 per patient). PMS36 Situation of Rheumatoid Arthritis Patients Treated with Biologics In Germany Based on a Claims Data Analysis Walzer S1, Schleich W1, Rex J2, Vollmer L1 Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Elsevier Health Analytics, Berlin, Germany
1MArS-
Objectives: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic joint disease in industrialized countries. This study provides information on the current supply with biological agents and its related costs in Germany. Methods: A retrospective claims data analysis was conducted utilizing the Institute for Applied Health Research (InGef) Berlin, formerly HRI Health Risk Institute, database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patients between 2012 - 2016 were included if they met the following conditions: Main diagnosis of RA (ICD-10 code M05.- and M06.-), and start / maintenance / switch of treatment with RA approved biological agent(s) (at least for three months). The study evaluated hospitalization, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: The level of share of prescriptions of all biological agents considered is low. Etanercept and adalimumab are administered mostly to patients already on treatment (in 2015 etanercept 32.7 % vs. adalimumab 28.9 %). The total costs of the included 4’233 patients add up to € 78’202’566 in 2015. The total number of patients, the number of hospital admissions and the total treatment costs including all individual cost items (costs of biological agents /other medication / outpatient care / hospitalizations) grew yearly on average between 7.7 % and 18.9 % (2012 – 2015). Hospitalization per patient remained constant at 0.8. Conclusions: Etanercept and adalimumab and are those biological agents mainly used by patients already on treatment. Costs grew steadily over the last four years. Total costs in 2015 were € 78.2 million (on average € 18’475 per patient). PMS37 A Cost Per Responder Analysis of Secukinumab Vs. Adalimumab Based on a Matching-Adjusted Indirect Comparison of Efficacy Data for the Treatmetn of Psoriatic Arthritis at 48 Weeks from the Irish Payer Perspective Gunda P1, Nikoglou E2, Jugl SM3, Murphy A4 1Product Life Cycle Services - NBS, Novartis Healthcare Pvt. Ltd., Hyderabad, India, 2Product Lifecycle Services - NBS, Novartis Global Service Center Dublin, Dublin, Ireland, 3Novartis Pharma AG, Basel, Switzerland, 4Novartis Ireland Ltd., Dublin, Ireland
Objectives: The objective of this analysis was to estimate and compare the cost per responder (CPR) in Ireland, based on the American College of Rheumatology (ACR) outcomes following 48 weeks of treatment for psoriatic arthritis (PsA) with the fully human anti-IL-17A antibody secukinumab (SEC) relative to the antiTNF antibody adalimumab (ADA). Methods: Results from a previous matchingadjusted indirect comparison (MAIC) based on FUTURE 2 and ADEPT RCTs was used to calculate the CPR for each treatment. Drug costs were estimated based on cost to the national Irish payer (including VAT, rebates and wholesaler margins) and the number of doses required for 48 weeks. Other cost domains like administration or high tech patient care fees were not included as this was considered to be equal for both treatments. Results: The MAIC analysis showed that ACR 20/50/70 response rates, which are key outcomes to determine improvement in PsA, were higher for SEC compared to ADA in biologic-naïve PsA patients. ACR 20/50/70 response rates were 80% /57% /32%; 74% /61% /43%; and 56% /44% /30% for SEC 150mg, SEC 300mg and ADA respectively. Cost per ACR20 responders were EUR 13,147, EUR 29,092 and EUR 27,674; cost per ACR 50 responders were EUR 18,320, EUR 34,831 and EUR 35,640; and cost per ACR70 responders were EUR 32,347, EUR 49,867 and EUR 52,273 for SEC 150mg, SEC 300mg and ADA respectively. Sensitivity analyses showed similar results and confirmed the robustness of the results. Conclusions: The 48 week CPR for all ACR 20/50/70 response rates were lower for SEC 150mg compared to ADA. These findings indicate that SEC 150mg dominates ADA by providing higher outcomes to lower cost for biologic-naïve PsA patients in Ireland.
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
modelled as an explanatory variable against the binary early retirement outcome, and adjusted for covariates including age, gender and BMI. Results: Adequate model fit determined. An odds ratio (OR) of 1.043 (p-value < 0.00) and average marginal effect of 0.6% (p-value < 0.00) per year of disease duration were calculated. The marginal effect was non-linear, increasing yearly with confounders held constant. The predicted probability for a patient to have retired due to RA after disease duration 1-5, 6-10 and > 10 years was 13.5%, 15.9% and 21.5% respectively. The likelihood that a patient had stopped working or retired early due to RA in the first 1-5 years of the disease increased across levels of current disease activity, with 5%, 9% and 15% across ‘remission’, ‘mild/moderate’ and ‘severe’ categories respectively. A ‘moderate/severe’ level of pain attributable to RA was found in 19% of patients in remission. Conclusions: Analysis suggests both disease duration and severity have an impact on the likelihood for a patient to retire early/stop working due to their RA. PMS33 The Impact of Disease Duration and Disease Activity on the Cost of Rheumatoid Arthritis: Results from Burden of Rheumatoid Arthritis Across Europe a Socioeconomic Survey (BRASS) Capron J1, De Leonardis F1, Fakhouri W1, Burke T2, Rose A2, Jacob I3 1Eli Lilly & Company, Indianapolis, IN, USA, 2HCD Economics, Warrington, UK, 3HCD Economics, Daresbury, UK
Objectives: Investigate the association between Disease Activity Score 28 C-Reactive Protein (DAS28-CRP) score, disease duration and patient costs in rheumatoid arthritis (RA) patients, using data from the Burden of Rheumatoid Arthritis across Europe: a Socioeconomic Survey (BRASS). Methods: Data were extracted from BRASS, a societal perspective observational RA dataset across 10 European countries (EU5, Denmark, Sweden, Hungary, Poland and Romania). 476 RA specialising clinicians provided information on 4,079 adult patients; of these, 2,087 patients completed corresponding questionnaires about the burden of RA. Twelve-month costs captured included: consultations, testing, hospital admissions and procedures, payments to professional caregivers, travel costs, requirement for aids/equipment and informal care costs. Indirect costs captured from the patient included work productivity impact. A generalised linear model was developed to investigate the association between disease duration, most recent DAS28-CRP score and total cost of patients excluding costs of conventional synthetic and biologic disease modifying drugs. Disease duration and DAS28-CRP score were modelled as explanatory variables against the total cost response variable, adjusted for covariates including age, gender and BMI. Results: The model provided adequate fit, uncertainty from between-country unit cost differences was investigated, and association between the variables of interest remained. The average marginal effect at the mean was calculated from regression outputs. Both disease duration and DAS28-CRP score had a statistically significant association with total cost; a unit increase in DAS28 score meant a total cost increase of € 1,075 (p= 0.004), whereas a unit increase in disease duration of one year increased total cost by € 360 (p= 0.012), with confounders age, gender, BMI and either DAS28-CRP or duration held at mean values. Descriptive analysis indicated that with greater duration of disease and/or disease activity, healthcare costs incurred outweigh treatment costs. Conclusions: Analysis suggests that disease duration and disease activity have a significant impact on total patient cost. PMS34 A Claims Data Analysis of Biological Agents for Psoriatic Arthritis In Germany Vollmer L1, Schleich W1, Rex J2, Walzer S1 1MArS- Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Elsevier Health Analytics, Berlin, Germany
Objectives: Approximately a third of patients with Psoriasis are developing Psoriatic arthritis (PsA). This study provides information on the current supply with biological agents and its related costs in Germany. Methods: A retrospective claims data analysis was conducted utilizing the Institute for Applied Health Research (InGef) Berlin, formerly HRI Health Risk Institute, database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances in Germany. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patient data from 2012 - 2016 were included if they met the following conditions: Main diagnosis of PsA (ICD-10 code L40.5), and start / maintenance / switch of treatment with PsA approved biological agent(s) (at least for three months). The study evaluated hospitalization, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: The level of share of prescriptions of all biological agents considered is low. Adalimumab and etanercept are administered mostly to patients already on treatment (in 2015 adalimumab 38.3 % vs. etanercept 31.3 %). Total costs of the included 1’545 patients add up to € 27’612’238 in 2015. The total number of patients, the number of hospitalizations and the total treatment costs including three out of four cost items grew yearly on average between 9.8 % and 13.1 % (2012 – 2015). The costs of other medication dropped yearly on average by 2.8 %. Average hospitalization per patient remained constant (0.6). Conclusions: Adalimumab and etanercept are those biological agents mainly used by patients already on treatment. Costs grew steadily over the last 4 years. Total costs in 2015 were € 27.6 million (on average € 17’872 per patient). PMS35 Treatment with Biological Agents Among Patients with Ankylosing Spondylitis in Germany: A Claims Data Analysis Schleich W1, Rex J2, Vollmer L1, Walzer S1 Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Elsevier Health Analytics, Berlin, Germany
1MArS-
Objectives: Over the past 15 years, the availability of anti-tumor necrosis factor inhibitors has altered the treatment approach of ankylosing spondylitis (AS). This
study provides information on the current supply with biological agents and its related costs. Methods: A retrospective claims data analysis was conducted utilizing the Institute for Applied Health Research (InGef) Berlin, formerly HRI Health Risk Institute, database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances in Germany. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patient data from 2012-2016 were included if they met following conditions: Main diagnosis of AS (ICD-10 code M45.-), and start / maintenance / switch treatment with AS approved biological agent(s) (at least for three months). The study evaluated hospital admission, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: Leading biological agents for 1st line treatment are adalimumab and etanercept at a low level of share of prescriptions. Both agents are administered mostly to patients already on treatment (in 2015 adalimumab 42.1 % vs. etanercept 30.0 %). Total costs of the included 1’342 patients add up to € 22’536’535 in 2015. Total number of patients, number of hospitalizations and total treatment costs including all individual cost items (costs of biological agents / other medication/ outpatient care / hospitalizations) grew yearly on average between 5.4 % and 11.1 % (2012 – 2015). Average hospitalization per patient remained constant at 0.6. Conclusions: Adalimumab and etanercept are those biological agents mainly used for treating AS. Costs grew steadily over the last four years. Total costs in 2015 were € 22.5 million (on average € 16’793 per patient). PMS36 Situation of Rheumatoid Arthritis Patients Treated with Biologics In Germany Based on a Claims Data Analysis Walzer S1, Schleich W1, Rex J2, Vollmer L1 Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 2Elsevier Health Analytics, Berlin, Germany
1MArS-
Objectives: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic joint disease in industrialized countries. This study provides information on the current supply with biological agents and its related costs in Germany. Methods: A retrospective claims data analysis was conducted utilizing the Institute for Applied Health Research (InGef) Berlin, formerly HRI Health Risk Institute, database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patients between 2012 - 2016 were included if they met the following conditions: Main diagnosis of RA (ICD-10 code M05.- and M06.-), and start / maintenance / switch of treatment with RA approved biological agent(s) (at least for three months). The study evaluated hospitalization, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: The level of share of prescriptions of all biological agents considered is low. Etanercept and adalimumab are administered mostly to patients already on treatment (in 2015 etanercept 32.7 % vs. adalimumab 28.9 %). The total costs of the included 4’233 patients add up to € 78’202’566 in 2015. The total number of patients, the number of hospital admissions and the total treatment costs including all individual cost items (costs of biological agents /other medication / outpatient care / hospitalizations) grew yearly on average between 7.7 % and 18.9 % (2012 – 2015). Hospitalization per patient remained constant at 0.8. Conclusions: Etanercept and adalimumab and are those biological agents mainly used by patients already on treatment. Costs grew steadily over the last four years. Total costs in 2015 were € 78.2 million (on average € 18’475 per patient). PMS37 A Cost Per Responder Analysis of Secukinumab Vs. Adalimumab Based on a Matching-Adjusted Indirect Comparison of Efficacy Data for the Treatmetn of Psoriatic Arthritis at 48 Weeks from the Irish Payer Perspective Gunda P1, Nikoglou E2, Jugl SM3, Murphy A4 1Product Life Cycle Services - NBS, Novartis Healthcare Pvt. Ltd., Hyderabad, India, 2Product Lifecycle Services - NBS, Novartis Global Service Center Dublin, Dublin, Ireland, 3Novartis Pharma AG, Basel, Switzerland, 4Novartis Ireland Ltd., Dublin, Ireland
Objectives: The objective of this analysis was to estimate and compare the cost per responder (CPR) in Ireland, based on the American College of Rheumatology (ACR) outcomes following 48 weeks of treatment for psoriatic arthritis (PsA) with the fully human anti-IL-17A antibody secukinumab (SEC) relative to the antiTNF antibody adalimumab (ADA). Methods: Results from a previous matchingadjusted indirect comparison (MAIC) based on FUTURE 2 and ADEPT RCTs was used to calculate the CPR for each treatment. Drug costs were estimated based on cost to the national Irish payer (including VAT, rebates and wholesaler margins) and the number of doses required for 48 weeks. Other cost domains like administration or high tech patient care fees were not included as this was considered to be equal for both treatments. Results: The MAIC analysis showed that ACR 20/50/70 response rates, which are key outcomes to determine improvement in PsA, were higher for SEC compared to ADA in biologic-naïve PsA patients. ACR 20/50/70 response rates were 80% /57% /32%; 74% /61% /43%; and 56% /44% /30% for SEC 150mg, SEC 300mg and ADA respectively. Cost per ACR20 responders were EUR 13,147, EUR 29,092 and EUR 27,674; cost per ACR 50 responders were EUR 18,320, EUR 34,831 and EUR 35,640; and cost per ACR70 responders were EUR 32,347, EUR 49,867 and EUR 52,273 for SEC 150mg, SEC 300mg and ADA respectively. Sensitivity analyses showed similar results and confirmed the robustness of the results. Conclusions: The 48 week CPR for all ACR 20/50/70 response rates were lower for SEC 150mg compared to ADA. These findings indicate that SEC 150mg dominates ADA by providing higher outcomes to lower cost for biologic-naïve PsA patients in Ireland.