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Switching or Discontinuing Ankylosing Spondylitis Biologics Raises Medical Costs

October 31, 2020

Patients with ankylosing spondylitis who switch or discontinue their biologic within a year of starting it have higher health care utilization and medical costs compared with patients who stay with their index biologic, according to a study published online in the Journal of Managed Care & Specialty Pharmacy

“This analysis may encourage payers to weigh the additional costs associated with switching therapies or potential savings associated with remaining on current therapies during formulary decision making,” wrote researchers from Novartis Pharmaceuticals and KMK Consulting. “Moreover, these results suggest a need to identify and appropriately select treatments with sustained safety and efficacy to lessen the clinical and economic burden of discontinuing or switching biologic therapies.” 

The retrospective analysis of US administrative claims data included 791 adults with ankylosing spondylitis initiating a biologic treatment.  

Over 1 year of follow-up, 15.4% of patients switched from their index biologic to a new therapy, 31.5% discontinued their index biologic without switching to a new one, and 53.1% remained with their initial biologic, according to the study. 

Patients who discontinued their biologic or switched to another had higher all-cause health care resource utilization, with increased emergency department and outpatient visits, during follow-up, researchers reported. Compared with patients who remained on their index biologic, patients who switched biologics also had higher total health care costs ($66,573 and $71,280, respectively) due to increased medical ($12,043 and $13,897) and pharmacy ($54,530 and $57,384) costs.  

Patients who discontinued their biologic had the lowest total health care costs ($41,179) and pharmacy costs ($22,100)—but they had highest medical costs ($19,079), the study showed. Researchers pointed out the heightened medical costs may reflect unstable disease states. 

“Furthermore,” they added, “discontinuing biologics results in medication wastage from a payer perspective, as initiating a costly drug and not completing treatment causes an excess in medication and imposes an unnecessary economic burden.” 

Jolynn Tumolo


Yi E, Dai D, Piao OW, Zheng JZ, Park Y. Health care utilization and cost associated with switching biologics within the first year of biologic treatment initiation among patients with ankylosing spondylitis [published online ahead of print, 2020 Oct 12]. J Manag Care Spec Pharm. 2020;1-10. doi:10.18553/jmcp.2020.19433

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