Background The introduction of tumour necrosis factor alpha (anti-TNFα) blockers in the treatment of rheumatic diseases has significantly changed patient prognosis. Nonetheless, it is important to optimise their use whenever possible due to their high cost and possible side effects. This abstract aims to evaluate if tapering doses is a cost efficient strategy.
Purpose To describe the cost savings achieved from optimised etanercept and adalimumab in rheumatology patients and to verify that dose reduction or increased administration interval do not compromise treatment effectiveness.
Material and methods A retrospective study was conducted between September 2014 and September 2015 in rheumatology patients receiving etanercept or adalimumab who did not interrupt treatment during the study period and received optimised treatment. The pharmacy department database and medical history were reviewed. Dispensations to optimised patients were collected retrospectively, bearing in mind that they received a lower than usual dose, or a longer administration time interval than described in the data sheet (for etanercept >50 mg every 7 days or administration interval over 7 days vs adalimumab 40 mg or administration interval over 14 days). The savings obtained were calculated by subtracting the total annual amount using the standard scheme from the actual amount based on dispensations. To check treatment effectiveness, the Disease Activity Score (DAS28) was used, provided patients had maintained the optimisation schedule throughout the study period.
Results Of the 48 patients treated with etanercept or adalimumab, 22 (46%) were optimised, 11 (ankylosing spondylitis), 10 (rheumatoid arthritis) and 1 (psoriatic arthritis). Optimisations corresponded mainly to etanercept: 10 patients 25 mg every 7 days and 3 patients 50 mg for over 7 days; 9 patients received adalimumab for over 21 days. All patients had a DAS28 <2.6, without relapses. Total savings per year compared with standard dose were 118 649.3€.
Conclusion Increased administration interval or dose reduction (etanercept) to optimise the use of anti-TNFα is a cost efficient strategy.
No conflict of interest.
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