Annual healthcare costs jump by almost $25,000 with targeted therapy for atopic dermatitis that avoided costs from reduced hospitalizations and ER visits only partly offset, according to recently reported research findings.
Targeted therapy, principally
First author Richard Ta, Pharm.D., of The CHOICE Institute of the Department of Pharmacy at the University of Washington in Seattle, and his colleagues said the targeted therapy was associated with an increase in annual drug spending of $26,061 compared with those on nontargeted therapy, while decreases in annual outpatient ($909) and inpatient ($251) spending totaled just $1,160.
“Modest declines in inpatient and outpatient spending were insufficient to offset the substantial rise in pharmaceutical spending, resulting in a net increase in total health care costs,” wrote Ta and his colleagues in the discussion section of the paper, which was published online in late October. “Thus, managed care decision makers should balance pharmacy budget impact with potential reductions in acute and urgent care use while considering prior authorization criteria, patient affordability and adherence.”
In this context, targeted therapies mean treatments that zero in on the inflammatory pathways implicated as a cause of atopic dermatitis. In addition to Dupixent, those targeted therapies include
The unadjusted results reported by Ta and his colleagues showed decreased hospitalizations in the comparison group (from 7.0% to 6.6%) but a steeper decline in the targeted group (7.2% to 6.0%). The proportion of the patients with an ER visit ticked up slightly in the comparison group (from 16.2% to 16.9%) but fell in the targeted therapy group (from 19.0% to 17.9%). After various statistical adjustments, Ta and his colleagues reported that targeted therapy was associated with a 1.6-percentage-point decrease in the probability of any hospitalizations and a 1.7-percentage-point decrease in ER visits compared with the nontargeted-therapy group. They said that in relative terms that translated into a 23% decrease in hospitalization and a 10% decrease in ER visits.
When it comes to cost, the researchers found that, in addition to a drug cost increase and the overall healthcare spending increase of $24,901, almost all of that was due to the jump in drug cost spending; targeted therapy was also associated with higher annual out-of-pocket costs totaling $95. In the limitations section of the paper, they note that their calculations do not take into account manufacturer copay coupons or other assistance programs, so the out-of-pocket exposure figure may be higher than the actual experience.
Another limitation of their comparison between targeted and nontargeted therapy of atopic dermatitis is that almost all (9,247 of 9,320) of the patients in the target group were treated with Dupixent. It will take another study of patients prescribed other targeted therapies.
This study focused on hospitals, ER visits and prescriptions and their associated costs, and Ta and his colleagues said it was, to their knowledge, the first real-world study on the associations between targeted therapy and healthcare use and associated cost, Ta and his colleagues said. But elsewhere in the discussion section of the study, they point to cost studies that include quality-of-life data in the analysis that have shown the targeted therapies to be cost-effective. Those results, they wrote, highlight that “claims data alone cannot fully capture the comprehensive benefits of targeted therapy because they overlook factors such as indirect costs and other intangible benefits.”
Ta and his colleagues used the
