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SAT0240 Cost effectiveness of cyclosporine (sandimmunneoral®) treatment in early severe rheumatoid arthritis: the grisar study
  1. LG Mantovani1,
  2. A Belisari1,
  3. M Pisani1,
  4. G Pasero2,
  5. E Marubini3,
  6. F Priolo4,
  7. R Ferrara5,
  8. O Della Casa Alberighi6
  1. 1Center of Pharmacoeconomics
  2. 2Institute of Rheumatology, University of Pisa, Pisa
  3. 3Institute of Medical Statistics and Biometry, University of Milan, Milan
  4. 4Institute of Radiology, Catholic University, Rome
  5. 5Medical Department, Novartis Farma, Origgio, Italy
  6. 6Clinical Research and Development, Novartis Pharma, Basel, Switzerland


Background Rheumatoid Arthritis (RA) is a chronic, degenerative, disabling and costly disease, particularly in its early form. There is evidence that cyclosporine A (CsA) is a disease modifying antirheumatic drug (DMARD) and is effective in slowing down the joint damage progression of early RA.

Objectives To assess the economic profile of CsA.

Methods TECHNIQUE: Incremental cost effectiveness analysis (CEA). PATIENTS AND DATA: collected from the GRISAR study, a multicenter, prospective, long-term, open-label with a blinded radiological end-point, randomised study of CsA vs conventional DMARDs. ALTERNATIVES: CsA vs conventional DMARDs. PERSPECTIVE: Italian National Health Service. COSTS: direct healthcare costs (drugs, diagnostics, hospitalisations for serious a dverse events -SAEs-) expressed in Euro 2000. EFFECTS: progression in the eroded joint count (PEJC) according to the Larsen-Dale method and reduction in working capacity due to RA. OTUCOME: Incremental cost effectiveness ratio [ICERpejc = (Ccsa-Cdmards)/(PEJC csa-PEJC dmards)].

Results 248 early severe RA patients (F/M 196/52; mean age 48.7+11.9 yrs) were considered in this analysis. The mean duration of f-up was 3.9 years. Compared to conventional DMARDs, CsA patients showed higher costs for drugs (Euro 12340 vs 1300, p < 0.05), SAE and diagnostics (Euro 2540 vs 2430, P = NS), and total cost (Euro 14880 vs 3730, p < 0.05). The progression of RA measured through PEJC was slower in CsA patients compared to conventional DMARDs (1.9 vs 3.2, p < 0.05), resulting in an ICER of Euro 8,570 per erosion avoided. Compared to conventinal DMARDs, less patients in the CsA group stopped working because of RA (2.7% compared to 7.8%).

Conclusion This is one of the first prospective CEAs based on a prospective, long-term, randomised clinical trial with a pragmatic design in early RA. Our estimates show that CsA incremental effectiveness is achieved at a reasonable incremental cost. When considered in the perspective of early severe RA, CsA has a favourable pharmacoeconomic profile since CsA.

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