Effect of price increase of adrenocorticotropic hormone on treatment practices of infantile spasms

Abstract

Intramuscular adrenocorticotropic hormone putatively constitutes the most efficacious treatment for infantile spasms. Adrenocorticotropic hormone in the United States is an "orphan drug," made by a single manufacturer. The price of adrenocorticotropic hormone increased almost 14-fold on August 27, 2007. We sought to evaluate the impact of this price increase on treatment practices at our institution, using a retrospective chart review of all children with infantile spasms treated during 2007-2009. We identified 97 patients whose spasms were treated using antiepileptic drugs, and we determined the length of stay for those hospitalized to initiate adrenocorticotropic hormone. Patients before the price increase were more likely to have been treated with adrenocorticotropic hormone as first medication, and were hospitalized 2.2 +/- 0.5 S.D. days for initiation. Patients after the price increase were more likely to have been treated initially with oral antiepileptic drugs rather than adrenocorticotropic hormone (P < 0.002). Those commencing adrenocorticotropic hormone after the price increase were hospitalized significantly longer (5.1 +/- 0.6 days S.D., P < 0.001). Treatment choices need to be evidence-based, but other factors often influence them.

Figure 1

Length of stay for hospitalized patients to initiate adrenocorticotropic hormone therapy for infantile spasms was plotted vs date of hospitalization. Diamonds indicate stay prior to beginning therapy before the price increase of adrenocorticotropic hormone August 27, 2007; solid squares indicate stay prior to beginning therapy after the price increase of adrenocorticotropic hormone. Zero corresponds to strictly outpatient therapy. Grey line indicates the mean before the price increase; dashed line indicates the mean after the price increase. ACTH = adrenocorticotropic hormone.

Figure 2

Use of adrenocorticotropic hormone and other therapies as initial therapy before (left) and after (right) the price increase of adrenocorticotropic hormone. ACTH = adrenocorticotropic hormone.