Background Rheumatoid Arthritis (RA) is a chronic, degenerative, disabling and costly disease, particularly in its early form. There is evidence that cyclosporine A (CsA) is a disease modifying antirheumatic drug (DMARD) and is effective in slowing down the joint damage progression of early RA.
Objectives To assess the economic profile of CsA.
Methods TECHNIQUE: Incremental cost effectiveness analysis (CEA). PATIENTS AND DATA: collected from the GRISAR study, a multicenter, prospective, long-term, open-label with a blinded radiological end-point, randomised study of CsA vs conventional DMARDs. ALTERNATIVES: CsA vs conventional DMARDs. PERSPECTIVE: Italian National Health Service. COSTS: direct healthcare costs (drugs, diagnostics, hospitalisations for serious a dverse events -SAEs-) expressed in Euro 2000. EFFECTS: progression in the eroded joint count (PEJC) according to the Larsen-Dale method and reduction in working capacity due to RA. OTUCOME: Incremental cost effectiveness ratio [ICERpejc = (Ccsa-Cdmards)/(PEJC csa-PEJC dmards)].
Results 248 early severe RA patients (F/M 196/52; mean age 48.7+11.9 yrs) were considered in this analysis. The mean duration of f-up was 3.9 years. Compared to conventional DMARDs, CsA patients showed higher costs for drugs (Euro 12340 vs 1300, p < 0.05), SAE and diagnostics (Euro 2540 vs 2430, P = NS), and total cost (Euro 14880 vs 3730, p < 0.05). The progression of RA measured through PEJC was slower in CsA patients compared to conventional DMARDs (1.9 vs 3.2, p < 0.05), resulting in an ICER of Euro 8,570 per erosion avoided. Compared to conventinal DMARDs, less patients in the CsA group stopped working because of RA (2.7% compared to 7.8%).
Conclusion This is one of the first prospective CEAs based on a prospective, long-term, randomised clinical trial with a pragmatic design in early RA. Our estimates show that CsA incremental effectiveness is achieved at a reasonable incremental cost. When considered in the perspective of early severe RA, CsA has a favourable pharmacoeconomic profile since CsA.
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