EFFICIENCY GAPS IN SUBCUTANEOUS BIOLOGIC THERAPY: A REAL-WORLD DATA ENVELOPMENT ANALYSIS
Author(s)
Felipe Ribeiro Cabral Fagundes, PhD1, Marlon Correa, BSc2, Fernanda Franco Munari, MSc1, Wellington dos Santos, PhD1, Moacyr Campos, MD1, Mateus Frederico de Paula, MSc1, Dulcimara Johann, BSc2, Ismael Antiqueira Costa, MSc2, Camila Detzel Fleith, BSc2, Bruno Tirotti Saragiotto, PhD1, Sabrina Floriani, MSc2, Lívia Loamí Ruyz Jorge Paula, PhD1.
1Research and Data Science Division, Hi! Healthcare Intelligence, São José dos Campos, Brazil, 2Unimed Santa Catarina, Joinville, Brazil.
1Research and Data Science Division, Hi! Healthcare Intelligence, São José dos Campos, Brazil, 2Unimed Santa Catarina, Joinville, Brazil.
OBJECTIVES: Subcutaneous biologics represent a growing cost burden, yet spending patterns rarely reflect real-world therapeutic efficiency, allowing misallocation to persist undetected. This study applies DEA to map the efficient frontier of resource allocation across subcutaneous biologic therapies in three chronic disease care lines and quantify avoidable waste in current prescription patterns.
METHODS: Real-world observational study (January 2024-April 2025) in a Brazilian private health operator. Adults (≥18 years) receiving subcutaneous biologics for musculoskeletal, dermatological, or respiratory chronic conditions were included (n=101; 75.4% response rate). Each biologic-indication pair was treated as a decision-making unit (DMU). A Variable Returns to Scale, input-oriented DEA model estimated efficiency scores (0-1) using total cost per patient as input and a validated composite effectiveness index (0-100; EQ-5D-5L, HAQ, RAPID3, ACT, DLQI, PROMIS) as output. Peer references and input slack were identified per DMU. Sensitivity analyses excluded hospitalizations unrelated to the care line.
RESULTS: Eighteen DMUs were evaluated across three care lines. DEA identified biologics on the efficient frontier (score=1.0) in all lines, achieving effectiveness above 93 points at lower costs. Mean efficiency scores were 0.74 (musculoskeletal), 0.82 (dermatological), and 0.71 (respiratory). Critical gaps emerged: in ankylosing spondylitis, one agent scored 48 points below its frontier peer at equivalent cost; in allergic asthma, the most-prescribed agent operated 24 points below the efficient alternative; in psoriasis, the highest-volume therapy showed lower effectiveness at higher cost. Judicially obtained treatments consistently fell below the efficient frontier of their respective care lines. Aggregate input slack across suboptimal DMUs corresponded to an avoidable expenditure exceeding BRL 595,000, recoverable through reallocation without additional budget.
CONCLUSIONS: Prescription volume and therapeutic efficiency are systematically misaligned. DEA-guided reallocation toward frontier peers can recover over BRL 595,000 in avoidable costs while improving clinical outcomes, establishing DEA as an actionable framework for value-based governance of high-cost biologics.
METHODS: Real-world observational study (January 2024-April 2025) in a Brazilian private health operator. Adults (≥18 years) receiving subcutaneous biologics for musculoskeletal, dermatological, or respiratory chronic conditions were included (n=101; 75.4% response rate). Each biologic-indication pair was treated as a decision-making unit (DMU). A Variable Returns to Scale, input-oriented DEA model estimated efficiency scores (0-1) using total cost per patient as input and a validated composite effectiveness index (0-100; EQ-5D-5L, HAQ, RAPID3, ACT, DLQI, PROMIS) as output. Peer references and input slack were identified per DMU. Sensitivity analyses excluded hospitalizations unrelated to the care line.
RESULTS: Eighteen DMUs were evaluated across three care lines. DEA identified biologics on the efficient frontier (score=1.0) in all lines, achieving effectiveness above 93 points at lower costs. Mean efficiency scores were 0.74 (musculoskeletal), 0.82 (dermatological), and 0.71 (respiratory). Critical gaps emerged: in ankylosing spondylitis, one agent scored 48 points below its frontier peer at equivalent cost; in allergic asthma, the most-prescribed agent operated 24 points below the efficient alternative; in psoriasis, the highest-volume therapy showed lower effectiveness at higher cost. Judicially obtained treatments consistently fell below the efficient frontier of their respective care lines. Aggregate input slack across suboptimal DMUs corresponded to an avoidable expenditure exceeding BRL 595,000, recoverable through reallocation without additional budget.
CONCLUSIONS: Prescription volume and therapeutic efficiency are systematically misaligned. DEA-guided reallocation toward frontier peers can recover over BRL 595,000 in avoidable costs while improving clinical outcomes, establishing DEA as an actionable framework for value-based governance of high-cost biologics.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE303
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Budget Impact Analysis
Disease
Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Sensory System Disorders (Ear, Eye, Dental, Skin)