A budget impact analysis for making treatment decisions based on anti-cyclic citrullinated peptide (anti-CCP) testing in rheumatoid arthritis.

Abstract

Aim: Given that rheumatoid arthritis (RA) patients with high anti-citrullinated protein antibodies (ACPA) titer values respond well to abatacept, the aim of this study was to estimate the annual budget impact of anti-cyclic citrullinated peptide (anti-CCP) testing and treatment selection based on anti-CCP test results.Materials and methods: Budget impact analysis was conducted for patients with moderate-to-severe RA on biologic or Janus kinase inhibitor (JAKi) treatment from a hypothetical US commercial payer perspective. The following market scenarios were compared: (1) 90% of target patients receive anti-CCP testing and the results of anti-CCP testing do not impact the treatment selection; (2) 100% of target patients receive anti-CCP testing and the results of anti-CCP testing have an impact on treatment selection such that an increased proportion of patients with high titer of ACPA receive abatacept. A hypothetical assumption was made that the use of abatacept would be increased by 2% in Scenario 2 versus 1. Scenario analyses were conducted by varying the target population and rebate rates.Results: In a hypothetical health plan with one million insured adults, 2,181 patients would be on a biologic or JAKi treatment for moderate-to-severe RA. In Scenario 1, the anti-CCP test cost was $186,155 and annual treatment cost was $101,854,295, totaling to $102,040,450. In Scenario 2, the anti-CCP test cost increased by $20,684 and treatment cost increased by $160,467, totaling an overall budget increase of $181,151. This was equivalent to a per member per month (PMPM) increase of $0.015. The budget impact results were consistently negligible across the scenario analyses.Limitations: The analysis only considered testing and medication costs. Some parameters used in the analysis, such as the rebate rates, are not generalizable and health plan-specific.Conclusions: Testing RA patients to learn their ACPA status and increasing use of abatacept among high-titer ACPA patients result in a small increase in the total budget (<2 cents PMPM).

• Authors: Sang Hee Park, Xue Han, Francis Lobo, David Kratochvil, Dipen Patel
• Journal: Journal of medical economics (J Med Econ) Vol. 23 Issue 6 Pg. 624-630 (Jun 2020) ISSN: 1941-837X [Electronic] England
• PMID: 32075453 (Publication Type: Journal Article)

Chemical References

• Anti-Citrullinated Protein Antibodies
• Antirheumatic Agents
• Biomarkers
• Abatacept

Topics

• Abatacept (economics, therapeutic use)
• Anti-Citrullinated Protein Antibodies (analysis)
• Antirheumatic Agents (economics, therapeutic use)
• Arthritis, Rheumatoid (drug therapy, immunology)
• Biomarkers
• Body Weight
• Budgets (statistics & numerical data)
• Costs and Cost Analysis
• Female
• Health Expenditures (statistics & numerical data)
• Humans
• Insurance Carriers (economics, statistics & numerical data)
• Insurance, Health (economics, statistics & numerical data)
• Male
• Models, Econometric
• Severity of Illness Index
• Sex Factors