Skip to main content

Cost per Treated Patient for Etanercept, Adalimumab, and Infliximab Across Adult Indications: a Claims Analysis



This paper aims to estimate the annual cost of etanercept, adalimumab, and infliximab per treated patient across adult indications using US-managed care drug use data.


Adult patients who used etanercept, adalimumab, or infliximab were identified in the Thomson Reuters MarketScan® Commercial Claims and Encounters Database (Thomson Reuters Healthcare, Ann Arbor, MI, USA) between January 1, 2005 and June 30, 2009. The index event was the first use of etanercept, adalimumab, or infliximab preceded by a diagnosis for rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis. Patients were defined as either newly initiating or continuing tumor necrosis factor (TNF) blocker treatment based on their use during the 6 months before the index event. Annual cost per treated patient was the sum of the etanercept, adalimumab, and infliximab medication and administration costs during the 12 months following the index claim. Annual costs were calculated across all patients as well as within each indication group and patient type (new initiator or continuing).


In total, 21,652 patients met the study criteria (etanercept n = 12,065; adalimumab n = 5,685; infliximab n = 3,902); 43% of patients were new initiators. Patient characteristics were similar across treatment groups in terms of age (mean = 49, SD = 10) and gender (66% female). Across indications, the mean annual TNF-blocker cost per treated patient was $15,345 for etanercept, $18,046 for adalimumab, and $24,018 for infliximab. In new initiators, the TNF-blocker cost per treated patient across indications was $14,543 for etanercept, $16,978 for adalimumab, and $21,086 for infliximab; among patients continuing therapy, annual costs were $15,836 for etanercept, $19,457 for adalimumab, and $25,748 for infliximab.


Patients on etanercept had the lowest TNF-blocker cost per treated patient for adult indications when applying actual drug use from a US-managed care population. TNF-blocker costs per treated patient on adalimumab and infliximab were approximately 18% and 57% higher than etanercept, respectively, using real-world drug use data.

This is a preview of subscription content, access via your institution.


  1. Enbrel® (etanercept) [Prescribing Information]. lmmunex Corporation, Thousand Oaks, CA.

  2. Humira® (adalimumab) [Prescribing Information]. Abbott Laboratories, Abbott Park, IL.

  3. Remicade® (infliximab) [Prescribing Information]. Centocor, Inc., Malvern, PA.

  4. Hochberg A, Johnston S, John A. The incidence and prevalence of extra-articular and systemic manifestations in a cohort of newly-diagnosed patients with rheumatoid arthritis between 1999 and 2006. Curr Med Res Opin. 2008;24:469–480.

    PubMed  Article  Google Scholar 

  5. Langley RGB, Krueger GG, Griffiths A. Psoriasis: epidemiology, clinical features, and quality of life. Rheum Dis. 2005;64:ii18–ii23.

    Article  Google Scholar 

  6. Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58:851–864.

    PubMed  Article  Google Scholar 

  7. Sidiropoulos P, Hatemi G, Song I, et al. Evidencebased recommendations for the management of ankylosing spondylitis: systematic literature search of the 3E Initiative in Rheumatology involving a broad panel of experts and practicing rheumatologists. Rheumatology. 2008;47:355–361.

    PubMed  Article  CAS  Google Scholar 

  8. Moreland L. Rheumatoid Arthritis, 2nd ed. London: Remedica Publishing LTD, 2008.

    Google Scholar 

  9. Gabriel SE, Crowson CS, O’Fallon WM. The epidemiology of rheumatoid arthritis in Rochester, Minnesota, 1955–1985. Arthritis Rheum. 1999;42:415–420.

    PubMed  Article  CAS  Google Scholar 

  10. Reveille J. Epidemiology of spondyloarthritis in North America. Am J Med Sci. 2011;341:284–286.

    PubMed  Article  Google Scholar 

  11. Blom M, Kievit W, Kuper H, et al. Frequency and effectiveness of dose increase of adalimumab, etanercept, and infliximab in daily clinical practice Arthritis Care Res. 2010;62:1335–1341.

    Article  CAS  Google Scholar 

  12. Chen YF, Jobanputra P, Barton P, et al. A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Health Technol Assess. 2006;10:iii–iv, xi–xiii, 1–229.

    PubMed  Google Scholar 

  13. Bartelds GM, Krieckaert C, Nurmohamed M, et al. Development of antidrug antibodies against adalimumab and association with disease activity and treatment failure during long- term follow-up. JAMA. 2011;305:1460–1468.

    PubMed  Article  CAS  Google Scholar 

  14. Pascual-Salcedo D, Plasencia C, Ramiro S, et al. Influence of immunogenicity on the efficacy of long-term treatment with infliximab in rheumatoid arthritis. Rheumatology. 2011;50:1445–1452.

    PubMed  Article  CAS  Google Scholar 

  15. Moots RJ, Haraoui B, Matucci-Cerinic M, et al. Differences in biologic dose escalation, nonbiologic and steroid intensification among three anti-TNF agents: evidence from clinical practice. Clin Expert Rheumatol. 2011;29:26–34.

    Google Scholar 

  16. Klareskog L, Gaubitz M, Rodriguez-Valverde V, et al. A long-term, open-label trial of the safety and efficacy of etanercept (Enbrel) in patients with rheumatoid arthritis not treated with other diseasemodifying antirheumatic drugs. Ann Rheum Dis. 2006;65:1578–1584.

    PubMed  Article  CAS  Google Scholar 

  17. Foerder CA, Rogge MC. Enbrel (etanercept). Dev Biol (Basel). 2002;109:99–102.

    CAS  Google Scholar 

  18. Huang X, Gu N, Fox K, et al. Comparison of methods for measuring dose escalation of the subcutaneous TNF antagonists for rheumatoid arthritis patients treated in routine clinical practice. CMRO. 2010;26:1637–1645.

    Article  CAS  Google Scholar 

  19. Harrison D, Huang X, Globe D. Dosing patterns and costs of tumor necrosis factor inhibitor use for rheumatoid arthritis. AJSP. 2010;67:1281–1287.

    CAS  Google Scholar 

  20. Ollendorf D, Kingman D, Hazard R, et al. Differences in annual medication costs and rates of dosage increase between tumor necrosis factor-antagonist therapies for rheumatoid arthritis in a managed care population. Clin Ther. 2009;31:821–835.

    Article  Google Scholar 

  21. Gu N, Huang X, Fox K, et al. Claims data analysis of dosing and cost of TNF antagonists in rheumatoid arthritis. Am J Pharm Benefits. 2010;2:351–359.

    Google Scholar 

  22. Weycker D. Retrospective study of the costs of care during the first year of therapy with etanercept or infliximab among patients aged > or = 65 years with rheumatoid arthritis. Clin Ther. 2005;27:646–656.

    PubMed  Article  Google Scholar 

  23. Wu E, Chen L, Birnbaum H, et al. Cost of care for patients with rheumatoid arthritis receiving TNF-antagonist therapy using claims data. Curr Med Res Opin. 2007;23:1749–1759.

    PubMed  Article  Google Scholar 

  24. First Databank, Inc. Wholesale Acquisition Costs (WAC). Available at: Accessed Sept 14, 2011.

  25. Schabert V, Watson C, Gandra SR, et al. Annual costs of tumor necrosis factor inhibitors using real-world data in a commercially insured population in the United States. J Med Econ. 2011. [Epub ahead of print].

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Machaon M. K. Bonafede.

Additional information

To view enhanced content go to

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bonafede, M.M.K., Gandra, S.R., Watson, C. et al. Cost per Treated Patient for Etanercept, Adalimumab, and Infliximab Across Adult Indications: a Claims Analysis. Adv Therapy 29, 234–248 (2012).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI:


  • TNF-blocker therapy
  • Administrative claims data
  • Annual cost