Mean annualized costs for the second course of treatment were highest for patients who switched to a different TNFi. Table?4 Cost of treatment with TNFi tumor necrosis factor inhibitor, United States dollars, confidence interval, not applicable Discussion One goal of this study was to assess clinical outcomes, MA-0204 duration of treatment, and costs of treatment associated with TNFi agents as a class rather than specific agents. interrupted therapy, and $14,200 for switched therapy; mean annualized costs for second course were $12,800 for interrupted therapy and $15,100 for switched therapy. Conclusion Patients who switched TNFi had higher pre-treatment DAS28 and higher overall costs than patients who received the same TNFi as either single or interrupted therapy. Funding This MA-0204 research was funded by Immunex Corp., a fully owned subsidiary of Amgen Inc., and by VA HSR&D Grant SHP 08-172. tumor necrosis factor inhibitor, rheumatoid arthritis Disease activity was assessed by the Disease Activity Score based on 28 joints (DAS28) [26], using erythrocyte sedimentation rate as the laboratory measure of inflammation. DAS28 before starting TNFi therapy was defined as the mean of all DAS28 values from VARA enrollment until 30?days after TNFi therapy start date, with most of these values measured within the first 5?days of initiating therapy. Post-treatment DAS28 was the mean of all DAS28 values beginning 90?days after TNFi therapy start date to allow time for the medication to take effect. Changes in DAS28 represent the difference between mean DAS28 before TNFi therapy and mean DAS28 after TNFi therapy for patients with values at both time points. Drug costs and associated administration costs were calculated using VA PBM prices, including a Blanket Purchase Agreement price for adalimumab and a Big 4 pricewhich is only available to VA, Department of Defense, Mouse monoclonal to CD48.COB48 reacts with blast-1, a 45 kDa GPI linked cell surface molecule. CD48 is expressed on peripheral blood lymphocytes, monocytes, or macrophages, but not on granulocytes and platelets nor on non-hematopoietic cells. CD48 binds to CD2 and plays a role as an accessory molecule in g/d T cell recognition and a/b T cell antigen recognition Public Health Service (Indian Health Service), and US Coast Guard customers [24]for etanercept and infliximab [21]. To approximate the most current drug costs, the January 1, 2013, to February 28, 2014, Federal Supply Schedule pricing was used to calculate adalimumab costs ($506.78 for 40?mg syringes); September 30, 2012, to September 29, 2017, pricing was used to calculate etanercept costs ($139.54 for 25?mg syringes and $279.08 for 50?mg syringes); and January 1, 2013, to February 29, 2016, pricing was used to calculate infliximab costs ($456.81 per 100?mg vial). The administrative cost for each treatment episode of etanercept and adalimumab was $25 (VA dispensing costs) and for each IV episode of infliximab was $169.09 (VA infusion costs). Total drug costs were the sum of the direct drug costs and the drug administration costs and are reported as the annualized cost of treatment by dividing the cost of the treatment course by the duration of the treatment course. Costs were calculated for the first course MA-0204 of TNFi treatment. Subsequent costs were then evaluated according to the initial drug assignment and calculated on an annualized basis. Second-course costs were based on the TNFi assignment for the agent that was selected for the second course of treatment. Statistical Analysis Continuous data are presented as means and 95% confidence intervals (CIs), and dichotomous data are presented as proportions and 95% CIs. The focus on CIs instead of values provides evidence for the stability of estimates along with statistical significance testingwhen the CIs do not overlap between two groups then the values are 0.05 and considered significantly different [27, 28]. The data analysis for this paper was generated using SAS software version 9.2 (SAS Institute Inc., Cary, NC, USA). Results Patients Of 1767 patients in the VARA registry at the time of analysis, 563 fulfilled the eligibility criteria to be included in this analysis, including 204 who initiated adalimumab, 290 who initiated etanercept, and 69 who initiated infliximab for their first course of TNFi treatment. The selection of these patients as part.
