STRUCTURED CARE PATHWAYS VERSUS HOME DELIVERY FOR TEMPERATURE-SENSITIVE BIOLOGICS IN IMMUNE-MEDIATED DISEASES: A REAL-WORLD PAYER ANALYSIS
Author(s)
Luiz Felipe Dipe Prates Miranda, MD, MBA1, Lívia Madeira, MD2, Maurício Guimarães, MBA3.
1IntraVita, Sao Paulo, Brazil, 2Cardoso Fontes Hospital, Rio de Janeiro, Brazil, 3IntraVita, São Paulo, Brazil.
1IntraVita, Sao Paulo, Brazil, 2Cardoso Fontes Hospital, Rio de Janeiro, Brazil, 3IntraVita, São Paulo, Brazil.
OBJECTIVES: To compare direct payer costs for a structured care pathway and home delivery of temperature-sensitive biologics in immune-mediated diseases, considering storage, monitoring, traceability, pharmacovigilance, and treatment selection.
METHODS: We combined a targeted literature review with a retrospective payer analysis using de-identified administrative data from June 2023 through May 2024. The review focused on domestic storage conditions, temperature excursions, patient knowledge, and clinical associations. The payer analysis included biologic users with rheumatoid arthritis, atopic dermatitis, asthma, psoriasis, psoriatic arthritis, spondyloarthritides, or inflammatory bowel diseases, drawn from the same insurance portfolio with comparable indication distributions and including patients initiating or continuing therapy. We compared a structured pathway, incorporating standardized protocols, pharmacist review, administration support, treatment monitoring, and first-line guidance, with home delivery of self-administered subcutaneous biologics without documented equivalents for these components. The primary outcome was direct payer PMPM cost in US dollars.
RESULTS: The review found frequent cold-chain problems with domestic biologic storage. In a Dutch study, 17/255 patients (6.7%) stored biologics within recommended conditions. Brazilian studies reported inadequate storage in 65.0%-82.7% of cases, with temperatures from -4.4°C to 15.5°C. In the payer dataset, monthly averages were 472 patients in the structured pathway and 1,546 in home delivery. PMPM costs were USD 1,034.74 for structured care and USD 1,846.94 for home delivery, a 78.5% higher cost with home delivery. The aggregated data did not allow determination of whether cost differences reflected storage conditions, adherence, treatment escalation, or initial therapy choice.
CONCLUSIONS: In this payer-based analysis, home delivery was associated with substantially higher PMPM cost than a structured pathway. This difference may reflect gaps in storage and monitoring, but also limited guidance on first-line selection and escalation. These findings suggest that biologic prescribing, delivery, and monitoring decisions should be addressed together in payer cost-management strategies.
METHODS: We combined a targeted literature review with a retrospective payer analysis using de-identified administrative data from June 2023 through May 2024. The review focused on domestic storage conditions, temperature excursions, patient knowledge, and clinical associations. The payer analysis included biologic users with rheumatoid arthritis, atopic dermatitis, asthma, psoriasis, psoriatic arthritis, spondyloarthritides, or inflammatory bowel diseases, drawn from the same insurance portfolio with comparable indication distributions and including patients initiating or continuing therapy. We compared a structured pathway, incorporating standardized protocols, pharmacist review, administration support, treatment monitoring, and first-line guidance, with home delivery of self-administered subcutaneous biologics without documented equivalents for these components. The primary outcome was direct payer PMPM cost in US dollars.
RESULTS: The review found frequent cold-chain problems with domestic biologic storage. In a Dutch study, 17/255 patients (6.7%) stored biologics within recommended conditions. Brazilian studies reported inadequate storage in 65.0%-82.7% of cases, with temperatures from -4.4°C to 15.5°C. In the payer dataset, monthly averages were 472 patients in the structured pathway and 1,546 in home delivery. PMPM costs were USD 1,034.74 for structured care and USD 1,846.94 for home delivery, a 78.5% higher cost with home delivery. The aggregated data did not allow determination of whether cost differences reflected storage conditions, adherence, treatment escalation, or initial therapy choice.
CONCLUSIONS: In this payer-based analysis, home delivery was associated with substantially higher PMPM cost than a structured pathway. This difference may reflect gaps in storage and monitoring, but also limited guidance on first-line selection and escalation. These findings suggest that biologic prescribing, delivery, and monitoring decisions should be addressed together in payer cost-management strategies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE304
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Biologics & Biosimilars, Gastrointestinal Disorders, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)