Value Propositions - October 2017

VBCR - October 2017, Vol 6, No 4 - Value Propositions


Smartphone Application Improves Self-Management Among Patients with Juvenile Idiopathic Arthritis

A smartphone application for self-management of juvenile idiopathic arthritis (JIA) demonstrated potential to improve healthcare outcomes among children and adolescents, according to the results of a recent study of the program.

In their study, Ran A. Cai, BSc, PhD, Arthritis Research UK Centre for Adolescent Rheumatology, University College London, United Kingdom, and colleagues created and tested JIApp, a self-management mobile application designed to remotely record symptoms and encourage self-management and healthcare engagement among patients with JIA.

“Through this app, YP [young people] are now able to record numerous additional parameters relating to their physical and psychological well-being, access relevant educational information and social support forums, receive treatment-related reminders, and improve communication with HCPs [healthcare professionals],” Dr Cai and colleagues explained.

Using a qualitative, user-centric approach, the investigators conducted the study in 3 phases, and interviewed patients with JIA, their parents, and healthcare professionals about JIApp. The 3 phases focused on (1) creating consensus on the application’s features, content, and design; (2) assessing and further refining the application; and (3) testing the usability of the application, respectively.

Among the population of 29 patients aged 10 to 23 years, 7 parents, and 21 healthcare professionals, Dr Cai and colleagues noted major themes in each of the study phases. These themes included remote monitoring of symptoms, well-being, and activities; adherence to treatment; and education (phase 1); adapting a reward system to motivate users; the application’s interface design; and integration of the application into clinical practice (phase 2); and overall satisfaction with, and affirmation of, the validity of content within the application (phase 3).

“Phase III usability testing demonstrated high rates of overall satisfaction with the app among YP [young people] and further affirmed the theoretical validity of the choices made in its design,” they said. Cai RA, et al. JMIR Mhealth Uhealth. 2017;5:e121.

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Hospital-Based Rheumatoid Arthritis Infusion Therapy Associated with Substantial Costs

Results from a recent study highlighted the significant costs hospitals incur for providing infusion therapy of intravenous biologics to patients with rheumatoid arthritis (RA).

Seeking to carry out a micro-costing analysis from a hospital perspective, Jordana K. Schmier, MA, Senior Managing Scientist, Exponent, Alexandria, VA, and colleagues developed an activity-based model for estimating costs associated with the provision of hospital-based infusion services (ie, preparation, administration, and follow-up) to patients with moderate-to-severe RA.

Using a spreadsheet, Ms Schmier and colleagues developed their model, and input factors such as hourly wage, time spent providing care, costs for supply and overhead, laboratory testing, infusion center size, and information about practice patterns. These values were sourced from published studies, surveys, standard cost sources, and expert opinion, and the modeled case focused on a hospital infusion center that catered to patients with RA being treated with abatacept, infliximab, rituximab, or tocilizumab.

Overall, annual infusion costs per patient were $36,663 for rituximab, $36,821 for tocilizumab, $44,973 for infliximab, and $46,532 for abatacept. Biologic drugs were the most expensive facet of RA infusion care, with 87% to 91% of annual overall costs dedicated to these treatments. However, overall costs were also increased substantially by personnel, supplies, and overhead expenses (8%-16% annually).

“Although the cost of administration is a small percentage of the costs associated with the biologic agent being infused, such costs can accumulate to substantial amounts with large patient volume, resulting in significant financial implications for the hospital if adequate reimbursement cannot be obtained,” Ms Schmier and colleagues said. Schmier J, et al. Clin Ther. 2017;39:1600-1617.

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Patient Support Program Associated with Greater Adherence Among Patients Receiving Adalimumab

Patients taking adalimumab who enrolled in a free patient support program to receive assistance with medication costs, nurse support, injection training, pen disposal, and medication reminders reported greater adherence, improved persistence, and a decrease in medical and total healthcare costs, according to the results of a recent study.

Because the effect of these services on adherence and autoimmune disease–associated medical costs in patients taking adalimumab has not been evaluated, David T. Rubin, MD, Joseph B. Kirsner Professor of Medicine, University of Chicago Medicine, IL, and colleagues sought to measure the association between participating in a patient support program and outcomes (ie, medication adherence, persistence, and direct medical costs) in patients starting therapy with adalimumab.

“This is one of the first studies to evaluate the impact of a multifaceted PSP [patient support program] for autoimmune diseases on adherence and health care costs. Enrollment in the PSP was associated with increased adalimumab adherence and persistence. In addition, mean reductions in medical costs (all-cause and disease-related) and total health care costs were observed in patients who enrolled in the PSP,” Dr Rubin and colleagues stated.

Using administrative claims data from Symphony Health Solutions and patient-level data from the patient support program for patients starting treatment with adalimumab between January 2008 and June 2014, the investigators conducted a long-term, retrospective, cohort study. They compared medication adherence and medical costs for emergency department, inpatient, physician, and outpatient visits at 12 months between biologic-naïve patients with Crohn’s disease, ulcerative colitis, RA, psoriasis, psoriatic arthritis, or ankylosing spondylitis who did and did not participate in the patient support program.

Of the 2386 patients included in the study, 1199 participated in the patient support program, and 1187 did not. During the follow-up period, adherence to adalimumab was 14% greater in the patient support program cohort than in those who did not participate in the program (67.0% vs 58.8%, respectively; P <.001). The rate of discontinuation for adalimumab was 14% lower among program participants than in those who did not participate (39.7% vs 46.2%, respectively; P = .001).

At 12 months, univariate analyses revealed that medical costs (excluding those for biologic treatments) were 23% lower for patients in the patient support program than for those who were not ($18,322 vs $23,679, respectively; P = .003). Overall, disease-related medical costs were 22% lower for program participants than for nonparticipants ($8001 vs $10,202, respectively; P = .045), and total costs were 10% lower for the same groups ($35,741 vs $39,713, respectively; P = .030).

“These findings suggest that enrollment in the PSP is associated with improved adherence to adalimumab and lower medical and overall health care cost (particularly inpatient cost),” Dr Rubin and colleagues asserted. Rubin DT, et al. J Manag Care Spec Pharm. 2017;23:859-867.

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Above-Label Dosing for Patients with Psoriasis Leads to Higher Treatment Costs

Above-label dosing (ie, a dose ≥10% higher than the dose indicated on the drug label) is widespread among patients with psoriasis being treated with etanercept, adalimumab, or ustekinumab, and in turn, leads to higher treatment costs, according to the results of a recent study.

Using a large, US claims database, Steven R. Feldman, MD, PhD, Wake Forest University, School of Medicine, Winston-Salem, NC, and colleagues carried out a retrospective analysis of data from 3310 patients with moderate-to-severe psoriasis who had filled ≥1 prescriptions for etanercept (n = 1443), adalimumab (n = 1447), or ustekinumab (n = 420) between January 1, 2011, and June 30, 2012, to evaluate the relationship between treatment costs and above-label dosing of those 3 drugs.

They examined the proportion of patients who engaged in extensive above-label use (ie, a dose ≥10% higher than the dose indicated on the drug label that is used for ≥180 days in 1 year), mean number of days above-label doses were used, and costs associated with extensive above-label dosing.

During 12 months of treatment, 20.0% of patients taking etanercept, 2.6% of patients taking adalimumab, and 14.8% of patients taking ustekinumab used extensive above-label dosing. The mean annual duration of use of extensive above-label dosing was similar and high (ie, exceeding 275 days) across all 3 biologic drugs. Additional costs per patient for the year that were attributed to extensive above-label dosing were $19,458 for etanercept, $18,972 for adalimumab, and $21,045 for ustekinumab; total costs for the year were $5,623,362 for etanercept, $701,964 for adalimumab, and $1,304,790 for ustekinumab.

“This study provides insights into the extensive above-label use of biologics in patients with moderate-to-severe psoriasis and documents resultant costs exceeding those that would have been incurred with on-label use,” Dr Feldman and colleagues reported. Feldman SR, et al. J Manag Care Spec Pharm. 2017;23:583-589.

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Last modified: November 30, 2017
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