Background Biologic drugs have improved outcomes of RA. However, many health care systems do not afford biologic drugs, and conventional DMARDs have to be used effectively including combinations. It was demonstrated in 2010 that good clinical outcomes of RA did not require wide use of biologics (Sokka et al CER 2013).
Objectives To compare clinical outcomes, medications, and medication costs of patients with RA in two rheumatology clinics with different traditions of DMARD use.
Methods Cross sectional observational clinical data of all patients with RA seen in 2012-13 in two rheumatology clinics, which both served a population of about 275,000. Clinical characteristics, disease activity, patient self-reported outcomes, and medications of the most recent visit were compared between the clinics using student's T-test, Chi Square, and nonparametric tests. Annual costs of medications to the society were calculated per 100 patients, using an assumption that a patient is taking current medications for one year.
Results Patient populations (n=1230 in Clinic1=C1 and 1495 in Clinic2=C2) were similar according to age (63 vs 62yr), gender (68-70%F), disease duration, and prevalence of seropositivity (Table 1); smoking habits were different (22% vs 13%). Disease activity was low and patients' functional status well reserved in both clinics. Remission criteria were met by 51% and 64% of patients. Biologic drugs were used more frequently in Clinic1 by 32.8% vs Clinic2 by 19.6% of patients while a combination of conventional anti-rheumatic drugs was used by <1% and 41%, respectively. Estimated annual costs of medications per 100 patients were €501,000 and €270,000.
Conclusions Data are confirmatory to previous observations that remission/low disease activity and good functional status can be reached in RA using expensive and less-expensive anti-rheumatic drugs, in 2012-13. Therefore, treating 1000 RA patients a year leads to 2.3 million Euros expenses/savings in medications, depending of what medications are used, without compromising outcomes including disease activity and patient reported outcomes.
Disclosure of Interest None declared
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