Biologic Agents Are the Top Cost of Infusion Therapy for RA

Biologic agents represent the highest single cost associated with rheumatoid arthritis (RA) infusion care, a new analysis finds, with personnel, supplies, and overhead costs contributing substantially to overall costs.

Jordana Schimier, MA, of Exponent, Inc, and colleagues conducted a micro-costing analysis from a hospital perspective, and developed a model that accounts for all identifiable costs associated with the provision of hospital-based infusion services (including preparation, administration, and follow up) for maintenance treatment of moderate to severe RA among US patients. The authors believe their model provides infusion center administrators with a reliable framework and tool for identifying and assessing the multitude of costs related to providing infusion therapy at their facilities. The analysis received support from AbbVie and was published in Clinical Therapeutics.

The overall modeled costs per patient per year of infusion therapy were as follows:

• Abatacept (Orencia), $46,532
• Tocilizumab (Actemra), $44,973
• Infliximab (Remicade), $36,821
• Rituximab (Rituxan), $36,663

The analysis did not consider the costs of biosimilar products.

Across all 4 treatments, drugs accounted for the greatest share of overall infusion costs, ranging from 86.6% per year in tocilizumab-treated patients to 92.6% per year in rituximab-treated patients.

Input for Data Analysis

The spreadsheet-based model included inputs such as hourly wages, time spent providing care, supply and overhead costs, laboratory testing, infusion center size, and practice pattern information. Base-case values were derived from surveys, published studies, standard cost sources, and expert opinions. Costs are presented in year-2017 US dollars using the Overall Medical Care component of the Consumer Price Index.

The researchers assumed that the same amount of time was spent on preservice and postservice activities (approximately 50 minutes) for the various products administered; time spent on administration of infusion therapy varied by product and matched specifications for total infusion time in each package insert. The model assumed that infusion services were predominantly delivered by nurses (91%), followed by nurse practitioners and physicians (4.5% each). Pharmacist and technician times per infusion and overhead costs related to infusion preparation were also estimated from study data. Where possible, infusion rates were obtained from package inserts; data from clinical trial publications were also used. Time estimates of a nurse’s management of infusion reactions were weighted by frequency of events.

To calculate the total drug consumption for infusions that required weight-based dosing, the patient weight was assumed to be 75 kg. Product labeling or clinical trial data were used to calculate maintenance dosing. The overall cost of infusions per year was based on the number of maintenance infusions of each product administered in a given year, which varied by product. The model did not consider switching treatments, adding other drug treatments, or dose escalation; the calculated costs per year of each infusion drug assumed a stable maintenance dose over the course of a year.

Wages were based on US national estimates for personnel involved in activities related to providing infusion services in the hospital, and used the latest estimates from the US Bureau of Labor Statistics. Costs of disposable supplies and the number of units required for the reconstitution and administration of infusion therapy were derived from data including that of Medi-Span Price Rx.

Other costs included in the analysis were non-labor pharmacy facility costs such as refrigeration, freezers, and storage costs; pharmacy facility labor costs related to maintaining the pharmacy but not related to direct patient care; infusion center facility non-labor costs such as rent, capital equipment, and costs of infusion equipment; infusion center labor costs; laboratory costs; and allocated overhead costs.

The Impact

The study authors said that cost-effectiveness analyses may inform payers’ decision making with respect to the selection of preferred infused agents and the choice between directing patients toward hospital-based infusion centers versus subcutaneous injection for patients with RA. They note that the cost-effectiveness of subcutaneously injected biologics compared with that of infusion therapy has been confirmed in multiple analyses in this patient population. Thus, if infusion therapy remains the appropriate clinical choice for managing a patient with RA, institutions should expect greater payer scrutiny of the setting where infusion services are delivered. An understanding of resource use patterns may make an individual biologic more or less attractive, and may influence a provider’s choice of therapy, given the availability of alternative treatments and treatment settings.

The researchers conclude that their analysis highlights the value of assessing a hospital’s infusion patient mix by disease or indication, based on whether other effective drugs are available in different dosage formulations (subcutaneous or oral) that can free up infusion center facilities and personnel to provide care to more patients in other therapy areas. “While the use of estimates from national and public sources have helped to create a generalizable model,” they say, “the hospital infusion cost model presented here can easily be modified to calculate local infusion administration costs based on values provided by an individual hospital.”