Background Until 2010 the cost of biological treatments in Rheumatoid Arthritis (RA) was increased annually by 15% in our hospital. Due this situation, in 1st January 2011, a Hospital Biological Drug Commission and Protocol of Biological Therapies were created to improve the cost-effectiveness usage of biological drugs in RA.
Objectives To evaluate the pharmacoeconomic impact associated with a biological therapy prioritization Protocol for RA patients in the Hospital of Sagunto.
Methods Observational, ambispective study comparing the associated cost of biotreated RA patients pre-protocol (2009-2010) versus post-protocol periods (2011-2012). Inclusion criteria: RA patients treated with Abatacept (ABA) Adalimumab (ADA), Etanercept (ETN) or Infliximab (IFX) for at least 6 months during the study period (2009-2012). The development of our prioritization protocol of biological therapies in RA patients was based on EULAR guidelines, NICE recommendations, cost savings associated with the use of etanercept 25 mg/week in our RA patients and immunogenicity biologic drug properties. Based on these clinical and cost- effectiveness appointments ETN was selected as 1st line therapy because our successful experience of ETN 25 mg/weekly in certain RA patients, its subcutaneous administration and lowest theoretical cost per patient in Spain.
Cost savings and economic impact were calculated using Spanish official prices.
Results In the pre-protocol period (2009-2010), total expenses were increased by €110,000, up to €1,761,000 in 2010 (€11,362 pat/year). After protocol implementation, total expenses decreased by €53,676 on the 2010-2011 period, and €149,200 on the 2011-2012 period. On the 2010-2011 period the cost of biological therapy per patient-year decreased €355 (€11,007 pat/year) and additional €653 (up to €10,354 pat/year) by 2012, with a cumulative effect of the protocol implementation of €1,008 per patient-year. In the pre-protocol period, the annual cost/patient was €10.812 with ETN, €10.942 with IFX, €12.961 with ADA and €12.739 with ABA. By 1st Jan 2013, the annual cost per patient was €9,469 with ETN, €10,579 with IFX, €11,117 with ADA and €13,540 with ABA.
Conclusions The creation of our Commission of Biological Therapies is key to rational management of RA patients and optimization of resources, allowing us to save €200,000 after 2-year efficiency protocol implementation.
Acknowledgements The authors wish to thank the members of the Sagunto Hospital Biological Drug Commission
Disclosure of Interest None declared
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