Background The Ankylosing Spondylitis (AS) is a chronic inflammatory disease characterized by low back pain and progressive stiffness of the spine. Even being a rare disease, the resulting incapacity, impaired quality of life and the long term pharmacological therapy cause big social and economical impacts. In Brazil the AS gains a special highlight because most of the patients are covered by the public health care therefore receiving free medical care and pharmacological treatment. The high costs involving the TNF-blockers (Etanercept, Adalimumab, Infliximab) and the reduced workforce, caused by the impairment of the disease, is a strategic point on financial planning of the health system. In our peer reviewed national literature, only one study had measured the cost of AS in the country, however, this study was performed before the biologic era, making it necessary to reevaluate the actual cost with the new therapy.
Objectives To Measure and characterize the costs related to AS care in a public outpatient clinic after the introduction of TNF-blockers as standard medication.
Methods During 2011-2012 AS patients assisted in a public outpatient Rheumatology clinic were randomly recruited. To assess the demographic, clinical and economical data every patient answered a form in which inquired about several aspects of their disease and their economic life in the last year. BASDAI and BASFI were obtained right after it. Direct Costs were defined as the economic amount directly involved with the disease and disability treatment including private and public spends. On the other hand, Indirect Costs were all private losses or welfare spends related with absent work days, pensions and unemployed compensations. All the costs were measured using as reference the national costs table published by the brazilian government in 2012. To convert the currency was used the mean value of Euro in 2012 (1,00 Euro =2,51 Reais).
Results 93 AS patients were included, being 76% of them men. The mean age was 43,95 years (21-69 years) and time of disease was 8,92 years (SD 7,32). HLA-B27 was positive in 72% subjects, 65% were being treated with TNF-blockers, BASDAI and BASFI means at baseline were 4,9 and 5,4 respectively. The total cost of this population was 1,762,720 euros/year resulting in 18,953 euros/year per patient. The costs distribution is shown in Fig. 1. 32 subjects were retired due to labor incapacity and 18 were receiving unemployed compensations, resulting in 150,463 euros/year.
Conclusions There is an increase of the costs in AS care after the biologics introduction in Brazil and this medication is the responsible for the major part of spends related with the disease.
Torres TM, Ferraz MB, Ciconelli RM. Resource utilisation and cost of ankylosing spondylitis in Brazil. Clin Exp Rheumatol. 2010 Jul-Aug;28(4):490-7. Epub 2010 Aug 30.
Disclosure of Interest None declared