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Costs of dose escalation among ulcerative colitis patients treated with adalimumab in Germany

The European Journal of Health Economics volume 20, pages 195–203 (2019)Cite this article

Abstract

Aims

We determined adalimumab utilisation and associated drug costs in patients with ulcerative colitis (UC), focusing on patients requiring dose escalation.

Methods

The retrospective cohort study analysed the de-identified prescription data of the Arvato Health Analytics (Munich, Germany) database (2010–2015) in adult UC patients undergoing adalimumab therapy.

Results

A total of 154 patients were newly treated with adalimumab (average 39.6 years, 53% females), with a mean dose of 2.93 mg/day. Within 12 months, 69 patients (45%) received a dose increase of > 50% (doubled dose in 48 patients; 32%), with the escalation reported at 169.3 ± 99.3 days. A subsequent dose de-escalation to the standard dose occurred in 50 (32%) of patients that initially had a dose increase of > 50% (after 94.7 ± 49.6 days). Direct drug costs were 28,846 € in the overall study population, 24,934 € in patients on standard dose, 36,094 € in patients with dose increase, and 32,742 € in patients with increase and subsequent decrease.

Conclusion

Dose escalation occurred frequently, and in one third of patients the dose was at least doubled. Dose escalations were associated with substantial increases in direct drug costs. Dose escalation of adalimumab can severely affect both the health care system and the drug budget of the physician. It needs to be considered that other biologic medications may constitute a more cost-effective alternative.

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Funding

This study was funded by MSD Sharp & Dohme GmbH, Haar, Germany.

Author information

Affiliations

  1. Market Access, MSD Sharp & Dohme GmbH, Haar, Germany

    Bernadette Pöllinger, Wolfgang Schmidt & Heidi Imhoff

  2. Gesundheitsforen Leipzig GmbH, Leipzig, Germany

    Anna Seiffert

  3. Versorgungsmanagement an der Friedrich-Alexander-Universität Erlangen-Nürnberg, Raum 5.255, Lange Gasse 20, 90403, Nuremberg, Germany

    Martin Emmert

Authors
  1. Bernadette Pöllinger
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  2. Wolfgang Schmidt
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  3. Anna Seiffert
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  4. Heidi Imhoff
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  5. Martin Emmert
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Corresponding author

Correspondence to Martin Emmert.

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Pöllinger, B., Schmidt, W., Seiffert, A. et al. Costs of dose escalation among ulcerative colitis patients treated with adalimumab in Germany. Eur J Health Econ 20, 195–203 (2019). https://doi.org/10.1007/s10198-017-0953-z

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  • DOI: https://doi.org/10.1007/s10198-017-0953-z

Keywords

  • Adalimumab
  • Ulcerative colitis
  • Drug utilisation
  • Observational
  • Economic analysis
  • Direct drug costs

JEL Classification

  • I11