Background Biological therapy is a major therapeutic tool to prevent clinical and radiological progression of rheumatoid arthritis (RA). However due to the high cost of it is not possible to use extensively in Colombia. Subsequently arises the need to implement strategies to obtain savings in health care of patients with RA in our health resource-limited setting.
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), by using strictly a T2T strategy for 24 months in a specialized center in RA and subsequently cost reductions obtained.
Methods A descriptive cross-sectional study was performed. Records of patients with moderate or severe disease activity from specialized in RA center were reviewed; these patients were considered potential candidates for biologic therapies and were followed-up under strictly T2T standards. Clinical follow-up 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). Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients and the aim of the study was to look at what percentage of patients who were in MDA/SDA disease activity reached a low disease activity or remission. Descriptive epidemiology was done, the medians were analyzed using t-Student assuming normality for DAS28 distribution and disease activity was analyzed using Pearson's statistics. Were analyzed cost reductions obtained through decreasing the number of eligible patients for biological therapies.
Results 622 patients were included in this study, 453 (72.8%) women and 169 (27.2%) men. Mean age 59.3 years. These patients came in moderate or severe disease activity (MDA/SDA) with DAS28 3.5 in average; at 24 months with T2T strategy by using only conventional DMARS 467 patients (75.1%) got remission or low disease activity (Rem/LDA) status with a DAS28 2.6 in average. The costs of biological therapy at this horizon of time (finishing 2014 and in US dollars) on average was 16.595 US dollars/year/patient, and possibly for 467 patients total amount in projected costs savings of preventing use of biologics was approximately 5'824.849 US dollars for a year, ranging between the cheaper biological and the most expensive (2'975.228 and 7'749.865 US dollars/year) respectively.
Conclusions The results of this study showed that is possible to decrease disease activity and at the same time obtain a significant reduction in costs of this illness (RA) by using a model with defined therapeutic goals like T2T and optimizing a multidisciplinary pharmacological and non-pharmacological approach. This is very important in those countries or environments with limited resources for health care.
Disclosure of Interest None declared