Purpose: Commercial managed care payers need to understand the potential financial impact of granting access to a product when making formulary decisions. Golimumab is an approved biologic therapy for treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). The purpose of this study was to estimate the potential budget impact by allowing access to golimumab in a hypothetical commercial health plan.
Method: A budget impact model, employing a third-party payer perspective and with a three year time horizon, was developed. Epidemiologic data were used to quantify the proportion of patients diagnosed with RA, PsA, or AS and currently treated with biologics. Current and forecasted market share sizes were applied for all biologic products in these indications in two scenarios: excluding golimumab and including golimumab. Pricing inputs for all biologics were based on wholesale acquisition cost (WAC) as of 04/01/2011 and 20% co-insurance covered by members. Infusion costs were computed from the 2010 Medicare Physician Fee Schedule. Adalimumab double dosing was not included in the model, and infliximab dosing was assumed to be 5mg/kg at all doses. Findings were calculated for a hypothetical plan with a population of 1,000,000 members.
Result: In a plan with 1,000,000 members, 1,991 were biologic users in the first year, 2,045 in the second year, and 2,088 in the third year. Total annual cost of treatment, total cost per member per month (PMPM), and total cost per treated member per month (TMPM) were similar for both scenarios across the three year time horizon.
Conclusion: Access to golimumab is budget neutral and does not impact the annual health care budget of a commercial health plan while adding another therapeutic option for patients. Table: Budget Impact of Golimumab
Excluding Golimumab | Including Golimumab | Cost Difference | % Difference | |
| Year 1 |
|
|
|
|
| Total Cost | $34.91 M | $34,90 M | -$6,705.27 | -0.02% |
| PMPM | $2.91 | $2.91 | $0.00 | -0.02% |
| TMPM | $1,461.12 | $1,460.84 | -$0.28 | -0.02% |
| Year 2 |
|
|
|
|
| Total Cost | $35.71 M | $35.71 M | -$3,122.21 | -0.01% |
| PMPM | $2.98 | $2.98 | $0.00 | -0.01% |
| TMPM | $1,455.15 | $1,455.02 | -$0.13 | -0.01% |
| Year 3 |
|
|
|
|
| Total Cost | $36.37 M | $36.37 M | $2,900.72 | 0.01% |
| PMPM | $3.03 | $3.03 | $0.00 | 0.01% |
| TMPM | $1,451.57 | $1,451.68 | $0.12 | 0.01% |
See more of: The 33rd Annual Meeting of the Society for Medical Decision Making