Objectives To estimate the annual cost in the use of biological therapy (BT) in patients with different rheumatic diseases when dose modifications are undertaken in daily clinical practice in a specialized outpatient clinic during 2016 and to compare the results with data obtained in 2013.
Methods Design: Cost minimization observational study under conditions of clinical practice. Patients: Patients with different rheumatic diseases who come to a specialized outpatient clinic on BT in the Rheumatologic department at a tertiary Spanish hospital (with a tight follow-up) that had been treated with BT under reduced doses during 2016 were collected. Protocol: Reductions in treatment dose or dose frequency were established empirically and were carried out by their rheumatologist in those patients who were in remission (DAS 28 <2,6) for at least 6 months without steroids. Main outcome: Reduction of annual average cost in euros in BT used in patients who are in dose reduction in clinical practice in 2016. Secondary outcome:Differences in annual costs reduction in 2016 compared with 2013. The cost reduction was calculated by comparing the actual expenditure (after modifying treatment dose in clinical practice) with the theoretical costs (official price) in case you had not made the adjustment. Statistical analysis: Sample descriptive analysis. Reducing annual absolute costs and by treatment after tapering down doses in clinical practice in 2016 and the differences found between 2013 were calculated.
Results During 2016, the dose of the BT of 168 patients (94 Subcutaneous BT and 74 intravenous BT) were modified in clinical practice after reaching clinical remission:mean of DAS 28 (mean±SD)=2.31±0.76 or BASDAI (mean±SD)=2.15±1.39 without radiographic progression. Most patients were women (n=113;67%)and had rheumatoid arthritis (n=103;62%) and the rest were distributed among: spondyloarthritis (n=28;17%), psoriatic arthritis (n=22;13%), juvenile idiopathic arthritis (n=10;5%) and Systemic Lupus Erithematosus (n=5;3%). No patients treated with certolizumab or anakinra was modified treatment doses. During this period, 5 patients discontinued BT (3 remissions and 2 minor adverse events). Table 1 shows the number of patients by type of BT and costs. The BT dose reduction in clinical practice during 2016 represented a saving of 676,501.67€ and a greater efficiency of treatments while in 2013, only 86 patients (30 etanercept, 15 adalimumab, 16 Infliximab (Remicade), 15 Tocilizumab IV and 55 Rituximab) had a modified dose of BT in clinical practice assuming a saving of 396,995.46€. The difference in the annual cost reductions in 2016 compared to 2013 meant a saving of 279.506,21€ more in the last year. Table 1.
Conclusions In rheumatic diseases we may do a dose de-escalation of BT in patients who go into remission and therefore we could reduce the associated costs of BT and being more efficient with the treatments. We believe that it is important to create specialized outpatient clinics on BT where a tight-control management of these patients and an individualized treatment are carried out.
Disclosure of Interest None declared