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And other news from the ISPOR 21st Annual International Meeting
VBCR - June 2016, Vol 5, No 3 - ISPOR 21st Annual International Meeting

In This Article




Managing Pain After TKA Significantly Lowers Total Hospital Costs

Washington, DC—Significantly lower hospital costs may be incurred by Medicare patients who receive bupivacaine liposome injectable suspension as a way to manage postsurgical pain after undergoing total knee arthroplasty (TKA), researchers have found.

Data were analyzed from 5 hospitals that are part of the Premier Database. Overall, 3359 Medicare patients who received the injectable suspension following primary TKAs between July 1, 2013, and March 31, 2015, were included, along with 5785 controls from the same hospitals who did not receive the injection after their surgeries between January 1, 2011, and March 31, 2015. Patients in both groups were similar with regard to age, sex, and Charlson Comorbidity Index; more whites were included in the experimental group than in the control group.

Mean hospital costs were $823 lower among patients who received the bupiv­acaine liposome injectable suspension, compared with patients who did not ($16,387 vs $17,210; P <.001). After adjusting for the hospital, age, sex, Charlson Comorbidity Index, and race, use of the injectable was estimated to statistically and significantly reduce total hospital costs (-$1020).

“The Comprehensive Care for Joint Replacement (CJR) program from Medicare will pay hospitals a fixed amount to cover all services from admission to 90 days after discharge for TKA to align incentives to reduce hospital costs for this common and increasingly prevalent surgical procedure,” the researchers explained. These data suggest that managing postsurgical pain with bupivacaine liposomal injectable suspension may alleviate hospital costs under the CJR program.

Dagenais S, Kang A, Scranton R. A comparison of total hospitals costs for Medicare patients undergoing total knee arthroplasty with or without bupivacaine liposomal injectable suspension. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 45745.

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New Model Identifies Shortcomings in Cost-Effectiveness Treatment Model

Payers should consider implementing a solid framework that addresses subsequent lines of therapy, and the impact of adverse events on mortality, to evaluate the cost-effectiveness of psoriatic arthritis (PsA) treatment, according to recent research.

Using a targeted literature review, investigators sought to propose an improved modeling approach for payers by evaluating existing health technology assessment submissions, and identifying shortcomings of current models. Factors such as proximity to clinical practice, treatment sequencing, as well as adverse events were taken into account during the analysis.

Initial treatment continuation was determined using a model of short-term response criterion (ie, PsA Response Criteria and/or changes in Psoriasis Area and Severity Index). Although the models allowed withdrawal from treatment because of adverse events or loss of efficacy in the long-term, the investigators identified several shortcomings, which they addressed in their model.

In particular, the proposed model took into account subsequent treatment lines, and the impact of adverse events on mortality, and allowed for inclusion of other factors, such as different population types—based on previous biologic treatment experience and PsA severity—and the ability to model subsequent biologic or conventional treatments.

Graham CN, Gunda P, Miles L, et al. A new cost-effectiveness framework for modeling psoriatic arthritis treatments. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 45299.

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Long-Term Adherence to Biologics Linked to Treatment Effectiveness Early On

Using an algorithm applied to claims data, investigators were able to determine that adherence to biologics during the second year of treatment may positively correlate with effective treatment in the first year among patients with rheumatoid arthritis (RA).

As part of their research, the investigators evaluated year 2 adherence in patients with RA who were effectively treated, or persistent with, initial biologic therapy during their first year of treatment. To be eligible for study inclusion, patients from the IMS PharMetrics Plus database had to have initiated treatment with a biologic between January 2009 and December 2012, and remain enrolled for 2 continuous years after they started biologic therapy. Treatment effectiveness and persistence were evaluated in all patients at year 1, whereas adherence was evaluated at year 2 in effectively treated and persistent patients; patients who were nonadherent in year 1 were evaluated separately at year 2.

The patient population eligible for inclusion (10,374) comprised 76.1% women, with a median age of 51 years; 77.9% were receiving a previously given disease-modifying antirheumatic drug. At year 1, approximately 30% of patients were effectively treated, whereas approximately 50% were persistent. Adherence was seen in 46.0% of patients in year 1, and 33.6% in year 2. Furthermore, the researchers found that patients who were effectively treated during the first year of therapy were significantly more adherent in year 2, compared with patients who were not treated effectively. Similar trends were seen among patients who were persistent in year 1, versus patients who were not.

“Establishing effective treatment in year 1 should result in improved adherence and maintained low disease activity in year 2,” the investigators concluded.

Stolshek B, De AP, Tang D, et al. Adherence of initial biologic during the second year in rheumatoid arthritis patients with one year of effective treatment. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 44856.

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Abatacept Has Better Cost per Responder Than Adalimumab

From a payer’s perspective, cost per response of abatacept is more favorable than that of adalimumab among patients with rheumatoid arthritis (RA) who are anti-citrullinated protein antibody–positive. Greater cost-savings were seen when more stringent American College of Rheumatology (ACR)70 and ACR90 response criteria were applied, and with increasing anti-citrullinated protein antibody levels, authors of a recent study have found.

“Effective treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) is a significant economic burden in the US healthcare system,” they explained.

Together with data from the AMPLE (Abatacept versus Adalimumab Comparison in Biologic-Naïve RA Subjects with Background Methotrexate) trial, the investigators used a decision tree to compare the costs per response of abatacept and adalimumab in a cohort of patients (N = 1000) with RA who are anti-citrullinated protein antibody–positive.

Overall, the cost per response in this patient population favored abatacept subcutaneous injections versus adalimumab subcutaneous injections for ACR20 ($5514 vs $5619), ACR70 ($10,094 vs $11,237), and ACR90 ($20,187 vs $36,002) responses, as well as Health Assessment Questionnaire Disability Index scores ($6134 vs $6540). In addition, the investigators observed that cost per ACR90—as well as cost per Health Assessment Questionnaire Disability Index score—consistently favored abatacept subcutaneous injections across anti-citrullinated protein antibody–positive quartiles, compared with adalimumab subcutaneous injections.

Walsem AV, Patel C, Johnston S, et al. Anti-ccp2 quartile comparison of the cost per response for abatacept compared to adalimumab based on ample in the United States. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 45135.

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Significant Economic Burden Linked to High Disease Activity in Patients with RA

Rates of healthcare resource use and economic burden are high among patients with rheumatoid arthritis (RA) who have higher disease activity per the Clinical Disease Activity Index, according to recent data.

Adult patients with RA (N = 3749), as defined by the International Classification of Diseases, Ninth Edition, were identified from a large claims database and an RA registry between 2006 and 2015. The mean age of the study population was 57 years, and 76% were women. Overall, 24.11% of the study participants had high disease activity, 31.93% had moderate disease activity, and 26.91% had low disease activity; 17.04% of the patients were in remission.

Average all-cause total costs were found to be $27,008—including $5262 in costs associated with RA—during the 12-month follow-up period of the study. In addition, the investigators observed that patients with higher disease activity made more frequent office visits (average, 12.31) compared with patients with moderate disease activity (11.79), low disease activity (11.71), and those in remission (11.59). Outpatient costs, as well as pharmacy costs, were found to be the primary cost drivers of all-cause and RA-related costs in patients with high, moderate, and low disease activity, in addition to patients in remission.

Kariburyo MF, Du J, Xie L, Baser O. Assessing the economic burden of rheumatoid arthritis patients with different clinical disease activity index scores: a probabilistic matching study. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 45566.

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Greater Disease Burden Seen in Patients with Tophaceous Gout

In an effort to describe patient characteristics and healthcare resource use among patients with and without tophi, researchers systematically assessed data from October 2012 patient chart audits, and identified category, dose of urate-lowering therapy, as well as patient characteristics.

Overall, the charts of 125 primary care physicians and 125 rheumatology patients were abstracted for the analysis (N = 1159). Approximately 24% of the patients had tophaceous gout. Compared with patients without tophaceous gout, these patients had gout for a significantly longer period of time (39 months vs 66 months), reported more flares annually (1.8 vs 2.5), and were more likely to have joint damage (6.6% vs 43.6%), the researchers observed. These patients were also more likely to have higher rates of cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, diabetes, depression, hypertension, osteoarthritis, and kidney stones.

Furthermore, the investigators reported that patients with tophaceous gout were more likely to be treated with urate-lowering therapy, and take colchicine and steroids than those without tophi; they were also less likely to take nonsteroidal anti-inflammatory drugs.

“Preventing the development of tophi or resolving crystal burden by treating to guideline targets remains a rarely achieved goal for patients with and without tophi,” the researchers concluded.

Tafesse E, Khanna P, Kabadi S, et al. The burden of tophaceous and non-tophaceous gout in the United States. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 44832.

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Better Adherence Linked to Oral Glucocorticoid Use Reduction in Patients with RA

Although there are therapeutic benefits associated with oral glucocorticoid use in patients with rheumatoid arthritis (RA), there are also side effects associated with use of the drug.

To determine whether rituximab adherence was associated with oral glucocorticoid use reduction in this patient population, researchers conducted a retrospective study using a large US claims database. Criteria for inclusion included patients who initiated rituximab between March 1, 2006, and March 31, 2011, were preindex exposed to anti–tumor necrosis factor-α therapy, as well as aged ≥18 years, and continuously enrolled for 12 months before and ≥270 days following index.

Of the 594 patients with a mean age of 55 years (women, 81%) who met criteria for inclusion, the researchers observed that oral glucocorticoid use probabilities significantly decreased with time and increasing proportion of days covered. The results suggested that increasing rituximab adherence was associated with statistically significant reduction of oral glucocorticoid use over time.

Johnston SS, Kamath T, Shi N, et al. Association between rituximab adherence and oral glucocorticoid use in rheumatoid arthritis patients with prior exposure to anti-tumor necrosis factor-alpha therapy. Presented at: International Society for Pharmacoeconomics and Outcomes Research 21st Annual International Meeting; May 21-25, 2016; Washington, DC. Abstract 32604.

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Last modified: July 12, 2016
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