Background Biologic Drugs have solid evidence in the treatment of the arthropathies, with similar efficacy data among different anti-TNF agents but are also associated with elevated direct costs.
Due to this fact, we felt the need to have a fast and practical method, in order to compare the real cost of the different therapeutic alternatives in our patients, as well as to identify eligible patients to optimize their treatments
Objectives To design and implement a quick and reliable method to determine the annual cost per patient (pp) and the individual patterns of dosages of the different Anti-TNF drugs used in arthropathies: rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. To compare mean cost of each treatment. To periodically inform physicians with real data about their patients, in order to try to optimize the treatments.
Methods In a first step, we make a retrospective analysis of all patients diagnosed with arthropathies and treated with Anti-TNF in our hospital from 2010 to 2012. We designed an Excel data sheet to determinate the cost and posologies of the drugs using the dispensation records of the Pharmacy Department. The next step was to validate the method, comparing the results with the publications available and corroborating the results with the Rheumatology department. After the necessary modifications, we determinate definitely the annual cost pp and posology (both in general, and for each rheumatic disease) of Adalimumab, Etanercept, Inflximab and Golimumab from January 2010 to August 2013. A detailed report with these results was submitted to the prescriptors. The last step was to make a full report of the year 2013 (Figure) to inform the physicians and to determine the influence of the previous report.
Results The global mean cost per patient in 2010 was €11.326 (n=289), €11.239 in 2011 (n=340) and €10.595 in 2012 (n=373). The estimated mean cost in 2013, using data from January to August was €10.587 (n=357), but after submit the mid-year reports and with the actions taken by the medical team, the mean final cost in 2013 was €9.852 (n=376). This represents an annual savings of €735 pp.
Analyzing each drug, mean annual cost pp was €9.749 for Etanercept, €10.493 for Golimumab, €11.503 for Adalimumab and €12.191 for Infliximab. After submitting to the clinicians the detailed reports, the percentage of intensified patients in 2013 went down from 3.4% to 1.86%.
Conclusions It is necessary to know our real cost of the different treatments with biological drugs and with this aim we developed a quick and reliable control method. With our method, Etanercept has demonstrated to be the Anti-TNF drug with the lowest annual cost pp in rheumatology. The implementation of this control method have enabled to our hospital to save €276.360 in one year.
III Actualizaciόn del Consenso de la Sociedad Española de Reumatología sobre terapia biolόgica en la artritis reumatoide. Rodríguez-Valverde, V. SER.
Indirect comparison of the effects of anti-TNF biological agents in patients with ankylosingspondylitis by means of a mixed treatment comparison performed on efficacy from published randomised, controlled trials. Migliore A. DARE 2012.
Disclosure of Interest B. Menchen Paid instructor for: Pfizer, V. Saavedra: None declared, A. Torralba: None declared