Rituximab (RTX) is increasingly used for the treatment of pemphigus and pemphigoid disorders. The high cost of RTX frequently limits its use and access.
Objective
To determine the health system resources and costs associated with RTX treatment of pemphigus and pemphigoid.
Methods
Health system resources and costs attributed to a convenience sample of 89 patients with either pemphigus or pemphigoid were identified, quantified, and valued 6 months prior to and following RTX initiation between May 2006 and August 2012. Overall cohort costs and costs per patient were calculated (2013 Can$).
Results
The overall cohort cost for 6 months pre-RTX was $3.8 million and for 6 months post-RTX was $2.6 million. The average cost per patient decreased from $42,231 to $29,423 (30.3% decrease). The main cost driver was intravenous immunoglobulin.
Conclusions
Our findings suggest that RTX is effective in reducing health system resources and the costs associated with the treatment of pemphigus and pemphigoid.
BystrynJC, SteinmanNM.The adjuvant therapy of pemphigus. An update.Arch Dermatol1996; 132: 203–12, doi:10.1001/archderm.1996.03890260105016.
4.
ZakkaLR, ShettySS, AhmedAR.Rituximab in the treatment of pemphigus vulgaris.Dermatol Ther (Heidelb)2012; 2: 17, doi:10.1007/s13555-012-0017-3.
5.
GurcanHM, KeskinDB, StemJN.A review of the current use of rituximab in autoimmune diseases.Int Immunopharmacol2009; 9: 10–25, doi:10.1016/j.intimp.2008.10.004.
6.
BaumS, GilboaS, GreenbergerS.Adjuvant rituximab therapy in pemphigus: a single-center experience of 18 cases.J Dermatolog Treat2013; 24: 427–30, [Epub 2013 May 21], doi:10.3109/09546634.2013.784391
LeventhalJS, SanchezMR.Is it time to re-evaluate the treatment of pemphigus?J Drugs Dermatol2012; 11: 1200–6.
18.
DaoudYJ, AminKG.Comparison of cost of immune globulin intravenous therapy to conventional immunosuppressive therapy in treating patients with autoimmune mucocutaneous blistering diseases.Int Immunopharmacol2006; 6: 600–6, doi:10.1016/j.intimp.2005.11.002.
19.
DaoudY, AminKG, MohanK, AhmedAR.Cost of intravenous immunoglobulin therapy versus conventional immunosuppressive therapy in patients with mucous membrane pemphigoid: a preliminary study.Ann Pharmacother2005; 39: 2003–8, doi:10.1345/aph.1E595.
20.
JohnstonKM, BolboceanC, ConnorsJ, PeacockS.Cost-effectiveness of rituximab in follicular lymphoma.Expert Rev Pharmacoecon Outcomes Res2012; 12: 569–77, doi:10.1586/erp.12.57.
21.
LaunoisR, PayetS, Saidenberg-Kermanac'hN.Budget impact model of rituximab after failure of one or more TNFalpha inhibitor therapies in the treatment of rheumatoid arthritis.Joint Bone Spine2008; 75: 688–95, doi:10.1016/j.jbspin.2008.04.012.
22.
PapaioannouD, RafiaR, RathboneJ.Rituximab for the first-line treatment of stage III-IV follicular lymphoma (review of Technology Appraisal No. 110): a systematic review and economic evaluation.Health Technol Assess2012; 16: 1–253, iii-iv.
23.
HallinenTA, SoiniEJ, EklundK, PuolakkaK.Cost-utility of different treatment strategies after the failure of tumour necrosis factor inhibitor in rheumatoid arthritis in the Finnish setting.Rheumatology (Oxford)2010; 49: 767–77, doi:10.1093/rheumatology/kep425.
