Terapias biológicas en artritis reumatoide:Análisis del coste de las alternativas terapéuticas

Resumo

Objective: Cost analysis of alternative biological therapies included in the Galician Central Autonomous Committee of Pharmacy and Therapeutics protocol for Rheumatoid Arthritis treatment. Material and methods: Descriptive study (April 2012) of rheumatoid arthritis patients being treated with biologics: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab and golimumab. Current medication regimen and annual treatment costs were determined. Cost savings are described assuming changes in treatment, from hospital- administered drugs to the ambulatory administration of medications as outpatients using the protocol recommended biologicals. Results: Of a total of 558 patients, 229 were treated with infliximab: 30 (13.1%) at a dose of 3 mg/kg, 173 (75.5%) with 5 mg/kg and 26 (11.4%) with 7 mg/kg; 27 with abatacept : 5 (18.5%) with doses of 500 mg, 19 (70.4%) with 750 mg and 3 (11.1%) at 1000 mg; 12 tocilizumab: 100% 8 mg/kg; 66 with rituximab 1000 mg, 14 with golimumab 50 mg, certolizumab 200 mg 5; 116 with etanercept 50 mg and 101 with adalimumab 40 mg. 95.78% (546) had previously received methotrexate. The average annual cost was calculated considering patients weighed more than 70 kg and shared vials in the case of drugs that are prepared under aseptic conditions: � 14,665 infliximab, abatacept � 14,695, � 14,140 tocilizumab, rituximab � 2,400 / dose, � 11,879 etanercept, adalimumab 12,895 �, certolizumab and golimumab � 11,888 � 10,316 / year. Following the hypothesis of change in treatments from day hospital to outpatient adminitration, estimated cost savings would amount to between 1245 and � 4,379 / per patient. Conclusions: As there is no study showing superiority of any of these drugs against the others in efficacy and safety, there should be a proper medicine selection that would ensure saving both material and personnel resources. It is important to consider certain factors such as administration frequency, possibility of lengthening the dosing interval, determinations of antibodies to drugs and diagnostic evaluations to improve the effectiveness / efficiency rate of treatments,in order to avoid a possible �therapeutic exhaustion �.