Background Until 2010 the cost of biological treatments in Psoriatic Arthropathy (PA) was increased annually by 11% in our hospital. In 1st January 2011, a Hospital Commission of Biological Therapies involving Rheumatology and Pharmacy services was created to improve the cost-effectiveness usage of biological drugs in PA. The main objectives of the Commission were to establishing procedures for the rational use of biological drugs, development of therapeutic protocols and establish programs of detecting, recording, assessment and reporting of adverse reactions to biological drugs. In order to improve the biological efficiency in PA patients, a therapy prioritization Protocol in PA patients was established. The aim of this protocol was to build a general framework for the use of these treatments within the hospital, while recognizing that this protocol does not cover all the possible situations, justifying the need for clinical interventions outside in the protocol.
Objectives To evaluate the economic impact associated with a biological therapy commission and prioritization Protocol for PA patients in the Hospital of Sagunto.
Methods Observational, ambispective study comparing the associated cost of biotreated PA patients pre-protocol (2009-2010) versus post-protocol periods (2011-2012). Inclusion criteria: PA patients treated with Adalimumab (ADA), Etanercept (ETN) or Infliximab (IFX) for at least 6 months during the study period (2009-2012). The development of our prioritization protocol of biological therapies in PA patients was based on EULAR guidelines, NICE recommendations cost savings associated with the use of etanercept 25 mg/week in our PA patients and immunogenicity biologic drug properties. Based on these clinical and cost- effectiveness appointments ETN was selected as 1st line therapy because our successful experience of ETN 25 mg/weekly in certain PA patients, its subcutaneous administration and lowest theoretical cost per patient in Spain, followed by ADA. Cost savings and economic impact were calculated using Spanish official prices.
Results During the study period (2009-2012) a median of 74±4 patients were treated with ADA, ETN or IFX. In the pre-protocol period (2009-2010), the total cost per PA patient year were €12,624 in 2009 and €12,225 in 2010. After protocol implementation, total expenses decreased by €133,313 in 1st Jan 2011 to 31st Dec 2012 period. On the 2010-2011 period, the cost of biological therapy per patient-year decreased €774 (€11,451 pat/year) and additional €308 (up to €11,143 pat/year) by 2012, with a cumulative effect of the protocol implementation of €1,082 per patient-year. In the pre-protocol period, the annual cost/patient was €11,480 with ETN, €12,952 with ADA and €15,342 with IFX. By 1st Jan 2013, the annual cost per patient was €10,657 with ETN, €11,183 with ADA and €12,234 with IFX.
Conclusions At a time when the cost of therapy is an unavoidable component in health care treatment decisions, the creation of a Commission of Biological Therapies is key to rational management of PA patients and optimization of resources, allowing us to save €133,313 after 2-year efficiency protocol implementation.
Borrás-Blasco J, et al. Expert Opin Biol Ther. 2014;14:145-50
Acknowledgements The authors wish to thank the members of the Sagunto Hospital Biological Drug Commission
Disclosure of Interest None declared
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