The impact of adoption of a new urate-lowering agent on trends in utilization and cost in practice

Yueh Lung Peng, Chien Te Lee, You Lin Tain, Yaw Bin Huang, Hung Yi Chuang, Yen Hsia Wen, Shiou Huei Huang, Chun Yu Tsai, Chien Ning Hsu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

8 Scopus citations

Abstract

Objectives Changes in treatment choice of therapy and size of treated population that can lead to under- or overestimate of payer’s budget are less likely to be reassured after reimbursement adoption of a new drug. The aim of this study was to evaluate the effects of febuxostat introduction and the modifications in its insurance coverage on the utilization and expenditure of urate-lowering therapy (ULT). Methods Electronic medical records for adults patients prescribed any ULT during 2010–2015 was derived from the largest medical organization in Taiwan. Aggregated estimates of ULT use and costs were assessed per 3-month and per patient per month (PPPM). Factors associated with total ULT expenditure were assessed using a time series design with factored Autoregressive Integrated Moving Average (ARIMA) models. Results ULT prevalent users increased 34.1% from 2010 to 2015 and a 123% increase in total ULT expenditure. Numbers on allopurinol and sulfinpyrazone both declined 31%, and on benzbromarone and febuxostat gradually increased to 38.21% and 22.89% of all users in 2015. Insurance payments PPPM ($4.44 to $9.22) and total monthly ULT cost ($32,946 to $ 85,732) growth more than doubled in 6 years, trend changes generated mostly by individuals switching to febuxostat. Conclusions ULT use moved to favor benzbromarone and febuxostat; greater expensive uptake for febuxostat led to a rapid rise in ULT cost. Marginal values of increasing access to febuxostat for asymptomatic hyperuricemia should be focus on future studies to facilitate drug prices negotiation and ensure appropriate ULT use.

Original languageEnglish
Article numbere0221504
JournalPLoS ONE
Volume14
Issue number8
DOIs
StatePublished - 01 08 2019

Bibliographical note

Publisher Copyright:
© 2019 Peng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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