Background Treatment adherence is particularly important in a serious, chronic disease like Rheumatoid Arthritis (RA). However several factors, such as the route of administration of the drug(s) and/or the clinical and logistical conditions of the patient, can have a negative impact on adherence. Abatacept (ABA) is a biologic drug indicated for the treatment of RA in combination with methotrexate that is commonly administered at hospital intravenously (iv), being the availability of its subcutaneous formulation only recent. The hospital iv administration is not only a setting which can potentially reduce adherence but it also implies additional costs for the patient and the caregiver(s) as well as for the health system. SuSTAin is a free, comprehensive, and integrated extra-hospital infusion Programme (Pr), available to Hospital Rheumatology Centres (HRC) and to patients who have been prescribed iv ABA, which was implemented in order to provide an infusion service outside the hospital with the aim of favouring treatment adherence and of reducing costs.
Objectives To evaluate the benefits of the Pr in terms of patients' adherence to treatment and reduction of costs in the three years experience of the SuSTAin Pr.
Methods To be eligible for the Pr, patients must have previously received at least 4 infusions of iv ABA at the HRC. The rheumatologist offers the Pr to the eligible patient who enters the Pr after providing his/her consent so that the subsequent infusions are administered outside the hospital as part of the Pr. A detailed record of the infusion timings, treatment adherence, infusion-related adverse events are collected by the nurses. In particular, any infusion-related adverse events are reported to the prescribing rheumatologist. Ongoing support is available through the SuSTAin telephone hotline.
Results Between November 2010 and November 2013, the Pr has managed more than 100 patients, corresponding to >1350 infusions performed at the patients' homes or at dedicated infusion centres outside the HRC. Data collected showed an improvement in adherence to therapy up to 100% in patients enrolled in the Pr when compared to a value of 93% when infusions were performed at HRC. Moreover, patients reported a decrease in the time spent reaching the HRC and waiting for infusions corresponding to about 150 minutes/patient/infusion. When estimating cost savings related to these transfer's and waiting's times, this translated into an average reduction greater than €30 per transfer and exceeding €50 per working hour lost per patient/caregiver(s).
Conclusions During three years of experience, the SuSTAin Pr provided an increase in treatment adherence to iv ABA treatment with respect to the HRC administration. In addition, an economic benefit for the patient and the caregiver(s) could be obtained.
References The numbers quoted in the abstract were collected by Domedica, the provider of the Pr.
Disclosure of Interest None declared