Background Given the high cost of Biological Therapies (BT) and the possible benefits of its optimization on patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PA), it has been carried out an observational study.
Objectives We analyzed the clinical and economic effect of the dose optimization.
Methods It was carried out an observational study in patients in treatment with biological therapy since March to September 2013. For the optimization (reduction of dose and/or dose interval spacing), patients were selected according to clinical remission (DAS28<2,6), low clinical activity (DAS28<3,2; BASDAI<4), or in function of medical judgment according patient assessment. The following data were collected: Diagnosis, BT, demographic characteristics, date and reduction/spacing of dose. The net price of the drug was used for the study cost.
Results In the time period analyzed, 364 patients were with BT, 204 (56.1%) with RA, 107 with AS (29,4%), 42 (11.5%) with PA. From all patients, 134 (36.8%) were candidates for the dose optimization, 72 patients (53.7%) with RA, 48 (35.8%) with AS, 14 (10.4%) with PA. The average age was 54 years, standard deviation (SD) 13, with female predominance (56%:45%).
84 patients were in clinical remission, 20 patients in low activity, and it was optimized the dose in 30 patients according medical judgment or concomitant pathology.
The optimization scheme is shown in the table.
At the end of the study all patients maintained the optimized dose, except in two cases where it was necessary to return to their initial regimen for worsening symptoms and increased skin lesions respectively.
The patient-year cost (theoretical dose) would be €835,538, while the optimization of dose was €594,102, which represents a saving of €241,435 (29%). The maximum saving was achieved by optimizing the treatments with Adalimumab and Etanercept, with 36% and 39% savings respectively.
Conclusions The optimization of BT allows reducing the cost and maintaining the effectiveness and safety of treatments.
The spacing in the doses of BT begins with proper selection of patients according to clinical criteria and disease activity and taking into account not only the economic cost.
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Disclosure of Interest None declared
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