Use of Biologic Agents to Treat Autoimmune Inflammatory Diseases Up 29% between 2009 and 2011

VBCR - June 2013, Volume 2, No 3 - Health Economics

By Wayne Kuznar

San Diego, CA—The use of biologic agents for autoimmune inflammatory diseases has been increasing between 2009 and 2011, according to a recent analysis of utilization data from commercial health plan members, which was presented at the 2013 Academy of Managed Care Pharmacy’s annual meeting. During that 3-year period, the overall increase of biologic drug use for autoimmune inflammatory disorders was 29.4%.

Overall, 27% of the patients who were approved by the plan to use a biologic anti-inflammatory agent actually use at least 1 of these agents between 2009 to 2011. Understanding utilization patterns of biologic agents is necessary to assess opportunities for specialty pharmacy management for these agents, according to Kevin Bowen, MD, and colleagues at Prime Therapeutics in Eagan, MN.

Of the approximate 2.6 million members (aged <65 years) who were continuously enrolled from 2009 through 2011, 3452 were newly initiated with a biologic drug during 2010 and 2011.

The biologic anti-inflammatory agents included in this analysis were abatacept (Orencia), adalimumab (Humira), alefacept (Amevive), ana­kinra (Kineret), certolizumab (Cimzia),  etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), tocilizumab (Actemra), ustekinumab (Stelara), and rituximab (Rituxan).
Over 3 years, 39,848 members had a diagnosis for which an anti-inflammatory biologic could be used, and 10,769 (27%) had a claim for ≥1 of the biologics. Some 42.5% of patients had a claim for a biologic for a diagnosis of rheumatoid arthritis (RA), 29.0% for psoriasis, 13.7% for Crohn’s disease, 3.8% for ulcerative colitis, and 11% for all other diagnoses.

Overall, the use of biologic anti-­inflammatory agents for autoimmune inflammatory diseases increased by 29.4%, from 241.8 to 312.8 per 100,000 members.
Of the members using a biologic agent on December 31, 2009, 77.2% (those with ulcerative colitis) to 82.0% (those with RA) were still using a biologic agent on December 31, 2011.

The mean incidence rate of any new biologic drug use in this analysis, by diagnosis, was:

  • RA, 6.7
  • Psoriasis, 4.4
  • Crohn’s disease, 2.4
  • Ulcerative colitis, 0.9
  • Ankylosing spondylitis, 0.9
  • Juvenile idiopathic arthritis, 0.3.

In this patient group, the most frequent biologics used by newly initiated patients with a diagnosis of RA, psoriasis, Crohn’s disease, or ulcerative colitis for adalimumab, etanercept, and infliximab between 2009 and 2011 are listed in the Table.

Overall, 27% of members who met the diagnostic criteria received a biologic anti-inflammatory agent over the 3-year study period between January 1, 2009, and the end of 2011, ranging from 6.5% of those with a diagnosis of ulcerative colitis to 59.1% with a diagnosis of ankylosing spondylitis.

The investigators note that patients recently initiating biologic and continuing therapy account for an increasing percentage of anti-inflammatory biologic drug utilization, noting that “health plans should understand that management strategies targeting choice of initial therapy may have an important impact on drug selection, but this approach will take many months to change utilization patterns.”

They further note that although health plans have a substantial cost for the increased use of biologic anti-inflammatory agents, which are known to improve outcomes, in this analysis there were 1205 members who were not receiving one of these agents; this is another reason that pharmacy management programs will need to focus on biologic anti-inflammatory agents to ensure that patients are receiving appropriate therapy.

Related Items
Increased Use of Sodium Channel Blockers May Reduce Costs in Partial-Onset Seizures
Chase Doyle
VBCN - July 2015 Volume 2, No 2 published on August 5, 2015 in Health Economics
Parameters Affecting Treatment Decisions for Patients with Multiple Sclerosis
Chase Doyle
VBCN - July 2015 Volume 2, No 2 published on August 5, 2015 in Health Economics
Unemployment Status Linked to Disability in Secondary-Progressive Multiple Sclerosis
Chase Doyle
VBCN - July 2015 Volume 2, No 2 published on August 5, 2015 in Health Economics
High Out-of-Pocket Cost of Biologic DMARDs Under Medicare Part D
Rosemary Frei, MSc
VBCR - June 2015, Volume 4, No 3 published on June 29, 2015 in Health Economics
Experts Make the Case for Putting Social Values Into Cost-Effectiveness Analyses
Rosemary Frei, MSc
VBCR - June 2015, Volume 4, No 3 published on June 29, 2015 in Health Economics
Mathematical Model Suggests It Is Cost-Effective to Combine Bariatric Surgery and Hip Replacement in Morbidly Obese Individuals
Rosemary Frei, MSc
VBCR - June 2015, Volume 4, No 3 published on June 29, 2015 in Health Economics
Prescription Drug Cost Sharing Parsed by Panel at Pharmacoeconomics Meeting
Rosemary Frei, MSc
VBCR - June 2015, Volume 4, No 3 published on June 29, 2015 in Health Economics
Inpatient Costs for MS-Related Disease Relapse Higher for Males Than for Females
Chase Doyle
VBCN - May 2015 Volume 2, No 1 published on June 1, 2015 in Health Economics
Inpatient Care Coordination Could Impact Clinical Outcomes, Duration of Hospital Stays
Chase Doyle
VBCN - May 2015 Volume 2, No 1 published on June 1, 2015 in Health Economics
Preventing Disease Relapse in Patients with Multiple Sclerosis May Reduce Associated Costs
Chase Doyle
VBCN - May 2015 Volume 2, No 1 published on June 1, 2015 in Health Economics
Last modified: May 21, 2015
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology