Background Etanercept (ETA) and adalimumab (ADA) are some of the biological agents available for treating severe psoriasis and a variety of inflammatory diseases in patients who have an inadequate response to standard treatment.

Purpose To analyse and evaluate current costs to the regional health system of the treatment of the following inflammatory diseases: Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA) with the main (self-injectable) anti-TNF drugs in Almería public hospitals (Spain).

Materials and methods Retrospective multicentre study including all patients treated with etanercept or adalimumab during the period January-December 2010 in all Almería public hospitals.

Results During the study period a total of 300 patients with AS, PsA or RA were treated; 112 (37.3%) received adalimumab and 188 (62.7%), etanercept; distribution of pathologies was: 51.6% RA, AS 29.7% and 18.7% PsA. The distribution per treatment indication was: RA (ADA 32.2%, 67.8% ETA), AS (39.3% ADA, ETA 60.7%) and PsA (48.2% ADA, ETA 51.8%). Average annual cost per patient for each therapeutic alternative was: RA (ADA 9931.6€, ETA 7363.5 €), AS (ADA 10162.5€, ETA 8146.2€) and PsA (ADA 6577.8€, ETA 8585.9€). In the light of these results and taking into account that the two drugs have similar efficacy, ETA appears to be the most favourable option in the treatment of RA and AS; PsA data with ETA could be influenced by double doses in dermatology-derived patients.

Conclusions For higher prevalence and incidence pathologies, etanercept is the most economical option, therefore it is proposed as first-line treatment, leaving adalimumab as a second line in case of lack of response. It is necessary to perform longer-term studies and include the rest of the anti-TNF drugs currently used to position each one in its maximum efficiency indication.