TABLE 5.
Unit Costs and Resource Use
| Product | Unit Cost | Frequency and Administration Mode | Source |
| Lipid panel | $97.00 | Includes: cholesterol, serum, total lipo-protein, direct measurement, high-density cholesterol, and triglycerides Administered 4-8 weeks following initiation of tofacitinib therapy |
Physician’s Fee and Coding Guide (HCPCS code 80061)43 |
| Atorvastatin | $0.73 (daily drug cost) | Used while on tofacitinib 20 mg daily Orally administered |
RED BOOK Online42 |
| Tuberculin or Mantoux test | $30.50 | Skin test: tuberculosis, intradermal Administered annually for all biologics |
Physician’s Fee and Coding Guide (HCPCS code 86580)43 |
| Chest x-ray | $109.00 (mid-point of cost range $97-$121) | Applied annually for all biologics | Physician’s Fee and Coding Guide (HCPCS code 71010)43 |
| Evaluation and management visit for x-ray | $53.00 (mid-point of cost range $ 45 -$61) | Annually for all biologics | Physician’s Fee and Coding Guide (HCPCS code 99211)43 |
| CBC with differential | $43.00 | Blood count: complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count). Administered before initiation for all biologics per ACR guidelines |
Physician’s Fee and Coding Guide (HCPCS code 85027)43 |
| Hepatic panel test | $61.00 | Includes: albumin, bilirubin, phosphatase, alkaline protein, total transferase, alanine aminotransferase, aspartate aminotransferase Administered on initiation for biologics, per ACR guidelines Five in the first 6 months and 2 in next 6 months for methotrexate |
Physician’s Fee and Coding Guide (HCPCS code 80076)43 |
| Treatment of pneumonia | $8,853 | Treatment for serious ADR | HCUPnet 20125 |
| Outpatient follow-up visit | $187.00 (mid-point of cost range $159-$215) | Costs for 2 visits were applied Treatment for ADR |
Physician’s Fee and Coding Guide (HCPCS code 99214)43 |
| Amoxicillin clavulanate | $2.36 (daily cost)(based on $23.60 for 20 tablets) | 7-day course; 875 mg tablet every 12 hours Treatment for minor ADR Orally administered |
RED BOOK Online42 |
| Primary care physician visit | $197.00 (mid-point of cost range $168-$226) | 1 visitTreatment for minor ADR | Physician’s Fee and Coding Guide (HCPCS code 99203)43 |
| Initiation visit | $197.00 (mid-point of cost range $168-$226) | At initiation of each biologic therapy | Physician’s Fee and Coding Guide (HCPCS code 99203)43 |
| Subsequent visit | $123.50 (mid-point of cost range $105-$142) | Visit every 3 months | Physician’s Fee and Coding Guide (HCPCS code 99213)43 |
| Training | $95.00 (mid-point of cost range $81-$109) | At initiation of biologic therapies administered as self-injection (etanercept, adalimumab, tocilizumab, certolizumab, and abatacept) | Physician’s Fee and Coding Guide (HCPCS code 99201)43 |
| Infusion | $504.50 (cost per hour)(mid-point of cost range $429-$580) | Tocilizumab: infusion over 1 hour Rituximab: infusion over 3 hours Abatacept: infusion over 1 hour See dosing schedule for applicable biologics |
Physician’s Fee and Coding Guide (HCPCS code 96413)43 |
| Abatacept injection | $864.08 (125 mg/mL syringe) | Injection once weekly Self-administered subcutaneous injection |
RED BOOK Online42 |
| Abatacept vial | $849.44 (250 mg vial) | Loading dose of 3 vials at initiation Administered by intravenous infusion |
RED BOOK Online42 |
| Adalimumab | $1,898.55 (40 mg/0.8 mL pen injector kit) | 40 mg every other week Self-administered subcutaneous injection |
RED BOOK Online42 |
| Certolizumab | $3,344.59 (400 mg/2 mL syringe kit) | 200 mg every 4 weeks Self-administered subcutaneous injection |
RED BOOK Online42 |
| Etanercept | $932.16 (50 mg/mL syringe) | 50 mg once weekly Self-administered subcutaneous injection |
RED BOOK Online42 |
| Rituximab | $774.07 (10 mg/mL vial) | One infusion of 1 gm, followed by a second infusion of 1 gm after 2 weeks. Course is repeated every 6 months. Administered by intravenous infusion |
RED BOOK Online42 |
| Tocilizumab | $819.48 (80 mg/mL vial) | One infusion of a 400 mL vial, followed by a subcutaneous injection every week Intravenous infusion and self-administered subcutaneous injection |
RED BOOK Online42 |
| To facitinib | $52.82 (cost per 5 mg tablet) | 5 mg twice a day Orally administered |
RED BOOK Online42 |
ACR = American College of Rheumatology; ADR = adverse drug reaction; CBC = complete blood count; HCPCS = Healthcare Common Procedure Coding System; Hct = hematocrit; Hgb = hemoglobin; RBC = red blood cell count; WBC = white blood cell count.