Background Until 2010 the cost of biological treatments in rheumatoid arthritis (RA) was increasing annually by 15% in our hospital. In order to improve the cost-effective use of biological drugs in RA, the hospital created the Biological Treatment Committee 1 January 2011. Their first decision was to establish a protocol for prioritising biological treatment based on efficiency in RA patients.

Purpose To evaluate the cost savings and economic impact associated with a biological treatment prioritisation protocol for rheumatoid arthritis patients in the Hospital of Sagunto.

Materials and methods This study was an observational, ambispective analysis comparing the cost of biotreated RA patients pre-protocol (2009–2010) versus post-protocol (2011–2012). Inclusion criteria: RA patients (American College of Rheumatology 1989 criteria) treated with abatacept (ABA), adalimumab (ADA), etanercept (ETN) or infliximab (IFX) for at least 6 months during the study period (2009–2012).

The Sagunto Hospital biological treatment prioritisation protocol in RA started 1 January 2011. This protocol based on efficiency criteria is presented in Figure 1. ETN was selected as 1^st line treatment because our experience of half-dose ETN 25 mg weekly in certain RA patients (EULAR 2013), its subcutaneous administration and lowest theoretical cost per patient in Spain.

The cost savings and economic impact associated with the protocol were determined by comparing the average cost per patient/year for biological drug during pre-protocol against post-protocol periods using official Spanish prices of Enbrel, Humira, Orencia and Remicade.

Results In the pre-protocol period (2009–2010), total expenses increased by 110,000 € to 1,761,000 € in 2010 (11,362 € pat/year). After the protocol was introduced, the total expenses decreased by 53,676 € over 2010–2011 and 149,200 over 2011–2012. Over 2010–2011 the cost of biological treatment per patient-year decreased by 355 € (11,007 € pat/year) and additional savings of 653€ (up to 10,354 € pat/year) were made 1 year later (2012), with a cumulative effect of the protocol implementation of 1,008 € per patient-year. We analysed the real cost of RA patient/year by biological drug. In the pre-protocol period (1 Jan 2010), the annual cost per treatment-naïve patient was 10,812 € with ETN, 10,942 € with IFX, 12,961 € with ADA and 12,739 € with ABA. In the post-protocol period (1 Jan) 2013 the annual cost per treatment-naïve patient was 9,469 € with ETN, 10,579 € with IFX, 11,117 € with ADA and 13,540 € with ABA.

Conclusions The creation of our Biological Treatments Committee developed rational management of RA patients and optimisation of resources. The decision to prioritise treatment according to our experience of use and cost-effectiveness rationale allowed us to save 200,000 € in the first two years.

No conflict of interest.