Background Evaluation of the direct costs of chronic diseases has become an essential tool in the adequate provision of health resources, which also implies an attempt to optimise treatments. Due to the high cost of biological drugs, this evaluation has a considerable importance in the treatment of rheumatic diseases.
Purpose To evaluate the dose patterns of etanercept (ETN), adalimumab (ADA) and infliximab (IFX) for the treatment of patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS) or Psoriatic Arthritis (PsA) in a tertiary hospital. To calculate the yearly average cost per patient of each drug according to clinical practice.
Materials and methods Retrospective study of patients treated with ETN, ADA and/or IFX for at least six months between January/2009 and April/2013 and diagnosed with RA, AS or PsA by the Rheumatology Department. Periods of treatment, doses dispensed in the hospital pharmacy and periods of temporary interruption, were obtained. The cost of each drug (official data) was: ADA 40 mg, 494.6 €; ETN 50 mg, 227.8 €; ETN 25 mg, 113.9 €; and IFX 100 mg, 516 €. Administration costs were added for the infusion of IFX (173.7 €).
Results 507 patients, 200 men/307 women, with a mean age of 57 years were included. 73.2% (371) of the patients had RA, 14.8% (75) PsA and 12% (61) AS. The cost per patient/year of biological treatment is shown in the following table. Statistically significant differences were also observed between the average percentage value of doses received and the theoretical dose (summary of product information): 85.0% for ETN, 101.66% for ADA and 112.48% for IFX (p < 0.001). No statistically significant differences were observed in the average length of treatment: 37.61 months, 38.32 months and 36.07 months for ADA, ETN and IFX, respectively (p = 0.444).
Conclusions Compared to the most common biological treatments, etanercept proved to be the most cost-effective treatment in these rheumatic diseases. Because there is a lack of studies evaluating the safety and efficacy between these drugs, establishing a cost-usefulness algorithm in the selection of these drugs should be considered, always paying attention to the presence of possible contraindications. This would result in a containment of the healthcare expenditure and an improvement in the efficiency of these treatments.
No conflict of interest.
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