Costs and Trends in the Usage of Biological Therapy for Rheumatoid Arthritis - A Retrospective Study

Abstract

Objectives: Rheumatoid arthritis (RA) autoimmune disorder is characterized by joint pain, stiffness, and impaired functionality. The disease is characterized for its variability in terms of the cost therapy, especially the biological one, compared to other treatment alternatives. We aimed to examine the costs in patients with RA receiving biological therapy and to describe global change in Disease Activity Score 28 (DAS28). MethOds: Under a T2T model, we followed patients with RA receiving biological therapy during 12 months; each patient had a minimum of 6 follow-up visits. Clinical follow-up was defined according to DAS28 as follows: every 3-5 weeks (DAS28> 5.1), every 7-9 weeks (DAS28≥ 3.1 and ≤ 5.1), and every 11-13 weeks (DAS28< 3.1). Tender joint count, swollen joint count and DAS28 were measured on each visit. We stratified patients in four groups: remission, low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA). Means and standard deviations were estimated for continuous variables and categorical variables were presented as percentages. We assessed the overall drug expenses; costs were presented in US dollars at the official rate of exchange for December 2017. Results: 606 were included, 83% were female, mean age was 60 years ±11. We achieved remission in 29.63 % of patients, and 22.56% in LDA (at overall 52.2% of response rate). Regarding therapy, 27% received Certolizumab, followed by Etanercept 17%, Abatacept 13%, Rituximab 9% Tocilizumab 9%, Golimumab and Tofacitinib 7%, adalimumab 6% and infliximab 4%. The cost therapy for 12 months was 5.039.840 Million/Dollars for all patients. cOnclusiOns: Our study showed an evident global improvement of DAS28 in a cohort of RA patients receiving biological therapy. Although the therapy is effective, ratios of cost-effectiveness should be considered by stakeholders; further research is needed using a greater sample to verify our results.