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VBCR - August 2016, Vol 5, No 4 - Lupus
Charles Bankhead

San Francisco, CA—Reductions in postinitiation treatment costs partly offset, but did not eliminate, the added cost of repository corticotropin injection (RCI) therapy for patients with systemic lupus erythematosus (SLE), researchers behind the analysis of an administrative claims database have found.

Prescription costs increased significantly (P <.01) after initiation of RCIs, but total medical and hospitalization costs decreased. Per-patient total medical costs remained approximately $4400 higher with RCIs, whether calculated as all-cause healthcare costs or SLE-related healthcare costs.

The study also showed that few patients with SLE initiated RCIs, with treatment beginning approximately 2 years after SLE diagnosis, Bingcao Wu, MS, Associate Director, HealthCore, Inc, Wilmington, DE, and colleagues reported at the Academy of Managed Care Pharmacy’s Managed Care & Specialty Pharmacy Annual Meeting 2016.

“Despite an increase in all-cause or SLE-related pharmacy costs after initiation of RCI, a medical cost offset was observed due to reduced hospitalization costs, which offset the drug costs by 32% to 37%,” Mr Wu concluded in a poster presentation. “Knowing the clinical and health economic profile of SLE patients who initiated RCI in a real-world setting lay the foundation for future research to explore factors associated with RCI initiation and its impact on long-term outcomes.”

RCI therapy is approved by the FDA for treatment of SLE exacerbations in select patients. The clinical and health economic profile of patients initiating RCIs remains unclear, however, providing a rationale for investigation.

The investigators retrospectively queried claims from the HealthCore Integrated Research Database for patients treated from January 2006 through March 2015. They identified patients who had ≥2 SLE-related diagnoses from July 2007 through March 2015, ≥6 months of continuous health plan enrollment from the index date, and ≥1 medical and pharmacy claims for RCIs.

The query yielded 29,401 patients with SLE, 29 (0.1%) of whom initiated RCIs. At diagnosis, the patients had a mean age of 45 years. Women accounted for approximately 90% of the patients initiating RCIs, and 28 patients had an active SLE flare at the time of RCI initiation.

On average, patients initiated RCIs 22.6 months after SLE diagnosis; follow-up after initiation averaged 23.9 months. Prior to initiation of RCIs, the most commonly used treatments were corticosteroids (439 patients per 1000 patient-years), antimalarials (311 patients per 1000 patient-years), immunosuppressants (275 patients per 1000 patient-years), and nonsteroidal anti-inflammatory drugs (256 patients per 1000 patient-years). After therapy with RCIs began, use of antimalarials decreased significantly (190 patients per 1000 patient-years; P = .04), but use of the other drug classes did not change significantly.

Among the 29 patients who initiated RCI therapy, hospitalization rates decreased—although not significantly—including all-cause (238 to 190 patients per 1000 patient-years) and SLE-related (183 to 138 patients per 1000 patient-years) hospitalizations. Similarly, nonsignificant decreases occurred in all-cause and SLE-related emergency department visits.

The number of all-cause outpatient services used per year decreased from 44 (before RCI therapy) to 40 (after RCI initiation; P <.01), but use of SLE-related outpatient services did not change (8-9 encounters per patient year). The number of all-cause and SLE-related prescription fills per patient-year decreased significantly: 44 to 39 (P <.01), and 15 to 10 (P <.01), respectively.

All-cause healthcare costs increased substantially after initiation of RCI ($6774 to $11,167 per patient per month; P = .07), driven primarily by increased prescription costs ($905 to $7443 per patient per month; P <.01). Total medical costs decreased ($5869 to $3724 per patient per month; P = .14), and hospitalization costs decreased significantly ($3192 to $799 per patient per month; P = .04).

With respect to SLE-related costs, the total increased significantly after initiation of RCI ($3077 to $7522 per patient per month; P = .04), again driven primarily by increased prescription costs ($66 to $6629 per patient per month; P <.01). Total medical costs decreased significantly ($3011 to $893 per patient per month; P = .02), as did hospitalization costs ($2444 to $434 per patient per month; P = .02).

“This study found trends of decreased healthcare resource utilization after RCI initiation, but most were not statistically significant due to small sample size,” the investigators concluded. “These results may have limited generalizability to a noncommercially insured population.”

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