All studies

PHN Z Score Photo with spacer-01.jpgThe real-world value of nine targeted immune modulators for the treatment of rheumatoid arthritis 



Of nine targeted immune modulators (TIMs) for the treatment of rheumatoid arthritis (RA), the two most expensive are also the most effective according to a real-world value assessment by Carelon Research (formerly HealthCore).

Enterprise Analytics Core domain(s): Immunology, value of integrated benefits, costs of care, quality of care, CarelonRx, policy guidance

Summary

Background

Cost-effectiveness analysis enables Elevance Health and CarelonRx to consider both costs and outcomes of competing medications when determining their relative value to our member population.

Objective

This study assessed the value of TIMs, also known as biologics, using real-world data for patients with RA.

Methods

  • Researchers conducted a cost-effectiveness analysis of TIMs using real-world claims data from RA patients with no prior use of TIMs between 2016 and 2020.
  • They adjusted for demographic and clinical differences using inverse probability of treatment weighting.
  • Effectiveness (% adequate response) was derived using a claims-based, validated algorithm1, and total costs included paid amounts from both medical and pharmacy claims.
  • Rebates were not accounted for in this analysis.
1JR Curtis, JW Baddley, S Yang, et al. Arthritis Res Ther. 2011;13(5):R155.


Results

  • Humira (adalimumab) and Enbrel (etanercept) were the most effective treatments and the most costly. All other TIMs were both less effective and less costly compared to Humira (Figure 1).
  • Estimated rates of inadequate response were high for all TIMs (70% - 95%). Low medication adherence (48% - 82%), TIM dose escalation (0% - 55%), and escalated dosing of oral glucocorticoids (16% - 21%) were the main contributing factors to inadequate response.

   Figure 1. Incremental Cost (Y) – effectiveness (X) of TIMs in comparison with Humira (Origin)

RA study figure.jpg


Key takeaways

  • CarelonRx’s preferred products, Humira and Enbrel, were the most effective agents for RA patients with no prior use of TIMs. These results support existing policy with real-world evidence and experience from Elevance Health’s members.
  • Targeted initiatives to improve adherence to Xeljanz (tofacitinib), Orencia (abatacept), Cimzia (certolizumab pegol), and Actemra (tocilizumab) may improve their effectiveness.
  • Dose optimization programs for Simponi (golimumab), Remicade (infliximab), and Actemra (tocilizumab), including oral glucocorticoid stabilization and optimization, may further improve the effectiveness of these agents.
  • CarelonRx is conducting sophisticated, real-world value assessments to support decision making.

Publication

Poster presented at the AMCP Nexus Conference 2022. Evaluating the Value of Targeted Immune Modulators for Rheumatoid Arthritis Using Real World Data from a US Commercially Insured Population.

Carelon Research project team: Nilesh Gangan, Michael Grabner, Amita Ketkar, Megan Reidy, Yaoxuan Xia



For more information on a specific study or to connect with the Actionable Insights Committee, contact us at [email protected].

Carelon Research, a subsidiary of Elevance Health, conducted this study in collaboration with CarelonRx. Dissemination and sharing of the Newsletter is limited to Elevance Health and its subsidiaries and included findings and implications are for Elevance Health and its affiliates’ internal use only.

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Highlighted Studies

A real-world study of immunoglobulin (IG) reveals multiple cost-saving opportunities 

Hub Domain(s): Immunology, oncology, costs of care, IngenioRx, policy guidance
Summary: 

  • Background: Immunoglobulins (IG) are costly blood-derived products accounting for more than $500m in annual spending in the Anthem membership
  • Methods: HealthCore examined IG utilization using claims data to evaluate appropriateness of use, the extent of site-of-care optimization and non-preferred IG use.
  • Results: The findings revealed significant off-label use of IGs (30%), including 22% for indications that were neither approved by FDA nor covered by Anthem, but were accepted by other health plans; and 8% for indications that were neither approved by FDA nor covered by any health plan
    • Additionally, 25% of the IG use was observed in the most expensive site of administration of hospital outpatient (HOPD) and non-preferred IG use accounted for 71% of the total IG use
  • Key Takeaways: Examining the IG uses from various dimensions presents several opportunities to IngenioRx and Anthem:
    • Reducing off-label IG use represented an estimated $27.8m annual savings opportunity
    • Shifting IG utilization from HOPD to a less expensive site of care could drive a further estimated $6.3m in annual savings
    • The study also identified opportunities to increase the share of preferred IG products used by our patients.


Major depressive disorder (MDD) patients highly impacted by COVID-19 face daunting challenges

Hub Domain(s): COVID, member experience
Summary: 

  • Background: Disruption to daily life and lockdown measures that were imposed in an attempt to contain the spread of COVID-19 presented new hurdles for at-risk populations, such as patients with major depressive disorder (MDD)
  • Methods: Conducted a 2020 internet survey to understand reasons for antidepressant continuation, switching and discontinuation in patients with MDD; COVID-19 pandemic questions were developed and added to survey.
    • COVID-19 Pandemic Impact (CPI) score was calculated and, based on their CPI scores, patients were categorized as experiencing low (LPI), medium (MPI) or high pandemic impact (HPI).
  • Results: Compared with LPI and MPI patients, HPI patients reported:
    • Significantly more problems accessing healthcare; few reported not having health insurance benefits due to loss of/reduced health insurance coverage (Figure 1).
    • More challenges obtaining depression prescription medications in terms of:
      • Filling new/current prescription(s)
      • Receiving samples from healthcare providers
      • Paying for prescription(s) due to loss of/reduced health insurance coverage and/or pharmacy benefits
    • Since start of COVID-19 pandemic engaged in significantly more:
      • Alcohol, drug, and tobacco use
      • Unhealthy mindless eating
      • Sedentary behavior
  • Key Takeaways: Our findings are consistent with literature showing that traumatic events, e.g. pandemics, can negatively impact health behaviors.
    • More research is needed to explore the COVID-19 impact in other patient populations.
    • Education opportunities exist for health plans to increase awareness among providers and patients of possible short and long-term COVID-19 effects on health behaviors.

Figure 1: Impact of COVID-19 pandemic on accessing healthcare/mental healthcare

  • Publications: Poster presented at the Virtual American Society of Clinical Psychopharmacology (ASCP) Annual Meeting, June 1-4, 2021

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