Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last 2 years in Colombia in a specialized in RA center. On the other hand costs of treating disease are increasing because introduction of biologic therapies.
Objectives The aim of this study was to describe the reduction in Disease Activity Score 28 (DAS28) in patients with moderate-severe disease activity (MDA/SDA) using a T2T strategy for 24 months in a Colombian specialized center in RA and cost savings for health care system associated with such reduction in disease activity levels.
Methods A descriptive cross-sectional study was performed. Records of patients from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11-13 weeks (DAS28 <3.1). In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients. The median was analyzed using t-Student assuming normality for DAS28 distribution.
Results 310 patients were included in this study, 256 (82.5%) women and 54 (17.4%) men. Mean age 61 years. These patients were in moderate-severe disease activity (MDA/SDA); mean DAS28 was 4.3 at the beginning, and after 24 months using T2T strategy and treating patients only with conventional DMARS we found that 252 patients (81.2%) got in remission-low disease activity (Rem/LDA) with a mean DAS28 of 2.6. On average, costs of biological therapy at this time was 16,595 USD/year for individual patient, and so for 252 patients costs savings were about 4.181.940 USD for a year, ranging between 2.975.228 USD (in case of most cheaper biological) and 5.824.849 USD (in case of using most expensive biological).
Conclusions This study showed that it is possible to decrease disease activity and therefore a significant reduction in costs, of moderate-severe disease activity (MDA/SDA) patients, by using a model with therapeutic goals and not only pharmacological.
Disclosure of Interest None declared