Impact of non-medical switching on healthcare costs: A claims database analysis

OBJECTIVES: This analysis evaluated the impact of non-medical switching (switching for a reason that is not medically related such as due to costs) from adalimumab (ADA) to another injectable biologic (certolizumab, golimumab, etanercept, or ustekinumab) on healthcare costs in patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or Crohn's disease following a formulary management change by large national payor. METHODS: Medically stable adult patients with ≥ 90 days continuous ADA use were identified in OptumInsight database (07/01/2012-06/30/2013). Patients who subsequently switched to another biologic (index date) following a payer formulary change and for no apparent medical reason between 01/01/2013-06/30/2013 were defined as non-medical switchers. Patients who remained on ADA therapy during this period were defined as maintainers and their index dates were chosen randomly. Patients with hospitalizations, emergency department (ED) visits, or substantial increases in ADA dose 6 months pre-index (baseline) were excluded to ensure medical stability. Outcomes included all-cause and indication-related medical (hospitalizations, ED visits, and outpatient visits) and total (medical and pharmacy) costs. T-tests and multivariate regression analyses were used to compare cohorts in costs incurred during the 6 months post-index (follow-up) and in costs difference from baseline to followup. RESULTS: Mean age was 46 and 48 years, respectively, for maintainers (n= 2,693) and switchers (n= 985). Switchers incurred significantly higher all-cause medical costs ($4,557 vs $3,310; P= .0011) and total costs ($21,996 vs $17,379, P< .0001) during follow-up vs maintainers. Differences from baseline to follow-up were significantly greater for non-medical switchers compared to maintainers in all-cause medical costs ($1,476, P< .0001) and total costs ($6,355, P< .0001). Adjusted regression analyses and indication-specific results yielded consistent findings. CONCLUSIONS: These real-world analyses of patients stabilized on ADA demonstrated that maintaining therapy with ADA was associated with significantly less healthcare expenditures compared to switching to another anti-TNF for a non-medical reason.