DESTIN, Fla. — The amount of Medicare spending for conventional DMARDs used to treat rheumatoid arthritis ballooned from $98 million in 2012 to $550 million in 2016, while spending on biologic DMARDs doubled from $4.3 billion to $8.6 billion, despite only modest increases in total beneficiaries, according to a presenter at the 2019 North American Young Rheumatology Investigator Forum.
“Rheumatoid arthritis is a disease that frequently affects the elderly population, with about a third of patients having an age on onset at or after 65 years, and hence a lot of patients with rheumatoid arthritis get covered by Medicare, which is the largest insurance carrier for elderly people in the United States,” Deepan Dalal, MD, MPH, a junior faculty member at the Brown University School of Medicine, told attendees. “Biologic DMARDs were introduced in 1998, and they have changed the face of rheumatoid arthritis treatment. They are very effective, but with that they have brought with them a cost factor.”
To evaluate Medicare spending trends for biologic and conventional DMARDs from 2012 to 2016, Dalal and colleagues compiled public data from CMS reports focusing on treatments administered by both Medicare Part B and Part D. The reports include total Medicare expenditures prior to rebates, beneficiary counts, unit drug costs, cost per beneficiary and doses administered.
Using these data, the researchers compared the spending and cost-per-unit trends of conventional and biologic DMARDs.
According to Dalal, despite only a modest increase in the total number of beneficiaries receiving conventional DMARDs, from 738,000 in 2012 to 1.1 million in 2016, spending on such treatments rose from $98 million to $550 million during that same time. The cost-per-unit of some conventional DMARDs “increased dramatically,” Dalal said. Costs for hydroxychloroquine rose 6.5-fold, from $0.29 to $1.90, while methotrexate costs increased $0.64 per unit to $1.73, and the cost of leflunomide more than doubled from $1.68 to $4.06.
Spending on biologic DMARDs doubled, from $4.3 billion to $8.6 billion from 2012 to 2016, despite a modest increase in the total number of beneficiaries, from 252,000 to 335,000. The highest increase in total spending among biologic drugs was for adalimumab (Humira, AbbVie), due to a large increase in the number of total beneficiaries and a 1.94-fold cost-per-unit increase. The cost-per-unit of infliximab (Remicade, Janssen), the most common infusion drug, increased by a factor of 1.26. However, its total number of beneficiaries remained stable.
“I think the data provides very useful clues about certain facts, one being that there has been a tremendous increase in cost, mostly driven by the increased cost per unit of the drugs, and hydroxychloroquine, among nonbiologic DMARDs, stands out in that regard,” Dalal said. “However, the cost increases for biologic DMARDs dwarfed that of conventional DMARDs by an order of magnitude. ... Of course, these increases in unit costs should be carefully considered to the relative benefits that these drugs provide.” – by Jason Laday
Dalal D. Trends in Medicare spending on disease modifying agents used to treat rheumatoid arthritis. Presented at: North American Young Rheumatology Investigator Forum; May 1, 2019; Destin, Fla.
Disclosure: Dalal reports no relevant financial disclosures.