Comparative analysis of the cost of pharmacotherapy schemes for patients with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is an unpredictable and progressive inflammatory disease of the joints of an immune nature, which in general for various reasons reduces the life expectancy of patients by 5 to 10 years. Pharmacotherapy of RA is based on long-term use of a large number of drugs of different pharmacotherapeutic groups, the cost of which varies significantly. The above makes the study of economic parameters of RA treatment an urgent problem.
 The aim of the study was to analyse the cost characteristics of pharmacotherapy of inpatients with RA in a hospital in order to optimize the cost of medication for these patients.
 The data of medical cards and medical records of 89 and 108 inpatients with RA, which were treated in the rheumatology department of the 4th Lviv City Clinical Hospital in 2009 and 2019, respectively, were selected as objects of the study. The methods of information retrieval, mathematical statistics, frequency, comparative, content analysis, data generalization, cost analysis were used.
 Disease-modifying antirheumatic drugs (DMARDs), glucocorticosteroids (GCs), and nonsteroidal anti-inflammatory drugs (NSAIDs) were grouped into six schemes for the RA pharmacotherapy in 2009 and 2019. An increase in the number of appointments of those schemes in which DMARDs were used has been established. The maximum share in both analysed periods was occupied by the triple pharmacotherapy scheme, which included all the above-mentioned drugs. This scheme was also the most expensive and its value at average retail prices (ARP) increased the most (9.4 times) from 2009 till 2019. During the analysed period, the average salary in Lviv region increased in 5.4 times, while the cost change indices (Ic) of different pharmacotherapy schemes, calculated on the basis of ARP, ranged from 6.9 for the two-component scheme with DMARDs and NSAIDs to 9.4 for the three-component scheme with DMARDs, GCs and NSAIDs. The analysis of affordability indices (Ia) showed that the most accessible was a two-component scheme, which included DMARDs and NSAIDs (Ia = 0.78). The study of the influence of the cost of the treatment schemes on the frequency of their prescribing using correlation analysis showed a very high dependence of these indices (R = 0.97). Pairwise correlations of pharmacotherapy appointment change indices (Iap) from Ic based on minimum (RPmin), maximum (RPmax) or average retail prices in Lviv pharmacies made it possible to establish a very high pair dependence of Iap from Ic calculated only on the basis of RPmax or ARP (R = 0.90).
 Thus, the analysis of patients' consumption of drugs for pharmacotherapy RA in the hospital allowed us to establish that in 2019 the treatment of RA became less available in comparison to 2009.