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P107. A budget impact model to evaluate medication persistence and associated healthcare costs

L. Yen1,2, R.D. Cohen3, M.B. Nichol4, J.D. McDermott Jr.5, G. Sharma5, T. Knight4, C. Shaefer5, P. Hodgkins6

1Shire Pharmaceuticals, Wayne, NJ, United States; 2Shire Pharmaceuticals, Wayne, PA, United States; 3University of Chicago Medical Center, Chicago, IL, United States; 4University of Southern California, Los Angeles, CA, United States; 5Covance Market Access Services Inc, Gaithersburg, MD, United States; 6Shire, Wayne, PA, United States

Aim: Low persistency for oral 5-ASA drugs is associated with increased risk of relapse of ulcerative colitis (UC) and subsequent costs [1,2]. A 1-year budget impact model was constructed to compare annual all-cause direct incremental costs of treatment for a given health plan per mild-to-moderate UC patient using oral 5-ASA drugs and associated persistency rates.

Methods: Assuming a budget holder's perspective for a 1-year horizon, the model analyzed the impact of persistency rates on total UC-related all-cause direct incremental costs. Persistency rates for Pentasa® 250 mg and 500 mg (7% and 10%, respectively), Colazal®750 mg (10%), Dipentum® 250 mg (10%), Asacol® 400 mg (9%), Lialda/Mezavant® XL 1,200 mg (20%) were derived from published literature [3]. UC patients within the health plan were distributed to drugs based on September 2009 market share data [4] and classified as persistent if they refilled within a timeframe of up to twice the duration of their prescription. Annual UC-related pharmacy costs were calculated using net wholesale acquisition cost, and additional all-cause direct incremental costs for patients with/without relapse were cited from published literature [5]. Sensitivity analyses for varying net drug costs and persistency rates were performed to determine impact on healthcare costs.

Results: Average annual all-cause UC costs per patient are shown in Table 1. Inpatient costs were lower for Mezavant XL ($5,667) compared with Asacol ($6,216) and lowest priced drug alternative Dipentum ($6,343). Sensitivity analyses indicated higher savings/patient for Mezavant XL than Asacol ($462 vs. $30, respectively). The primary driver for inpatient cost differences was the frequency of relapse reduced by persistency. A health plan with 1 million covered lives (2,300 UC patients) can save $401,000 ($0.03 per member/month) by switching 50% of UC patients to Mezavant XL.

Conclusion: This analysis illustrates the impact of medication persistence on reduction of UC relapse and associated healthcare costs. Health plans may achieve savings by including drugs with high persistency rates in their formulary.

1. Kane SV, et al. Am J Med. 2003;114:39–43.

2. Kane SV, et al. Dig Dis Sci. 2008;53:1020–1024.

3. Kane SV, et al. Poster presented at 40th Annual Digestive Disease Week.

4. IMS Health: US National Monthly Report on GI Core Market.

5. Mitra D, et al. Poster presented at 31st Annual Meeting of the Society for Medical Decision Making.

Table 1: Average all-cause cost of 5-ASA per mild-to-moderate UC patient
5-ASAAll-cause cost/patient
250 mg$13,135
500 mg$13,065
Colazal 750 mg$12,914
Dipentum 250 mg$12,804
Asacol 400 mg$12,688
Mezavant XL 1,200 mg$12,255