Session Title: Health Services Research
Session Type: Abstract Submissions (ACR)
Background/Purpose To investigate annually real-practice costs of biologic therapy for rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) cohort treated by tight control and treat to target strategy permitting dose reduction in Italian local health centre.
Methods 200 Italian patients in treatment with biologic therapy including all five TNFα inhibitors (adalimumab, ADA; certolizumab, CER; etanercept, ETA; golimumab, GOL; infliximab, IFX), abatacept (ABA), tocilizumab (TCZ) and anakinra (ANK) adhering to local health centre Asolo, in northeast of Italy counting population of 250.000 people, were investigated. ABA and TCZ were used as second and third biologic line. 127 were affected from RA, 39 from PsA and 34 from AS. All patients were controlled every 3 months for low disease activity or remission following EULAR criteria (DAS 28-CRP < 2.6 or ASDAS < 1.3). After achieving sustained remission for at least 12 months doses of biologics were reduced and maintained when activity permitted it. Real-practice costs were supplied by payment bureau of local health centre for the year 2013. Costs for eventual concomitant DMARDS, NSAIDs, steroids and other pain killers were excluded. Periods of treatment stops because of justified or unjustified causes were included.
Results Clinical remission by tight control and treat to target strategy was achieved in 81 RA (63.7%), 26 PsA (66.6%) and 22 AS (64.7%) patients. Dose reduction was very frequent for RA (49.6%), PsA (69%) and AS (44%); and significantly more frequent in patients treated with ETA (69.6%) than ADA (30.2%). Dose reduction was infrequent for the other biologics and beyond first biologic line. Total annual costs of biologics for the year 2013 were € 1.463.470, mean costs per patient per year were € 7.317. Mean annual costs per patient per year were € 5.736 for ETA, € 6.511 for CER, € 6.876 for ANK, € 7.867 for IFX, € 8.485 for TCZ, € 8.563 for GOL, € 9.285 for ADA and € 9.404 for ABA.
Conclusion a) Clinical remission was achieved by tight control and treat to target strategy in high number of patients with RA, PsA and AS; b) Dose reduction was very frequent in real-practice conditions; c) This was especially possible during ETA and first line biologic treatment; d) Permitting dose reduction importantly decreased expected annual costs for biologics in real-practice conditions.
E. De Menis,
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/annual-real-practice-costs-of-biologics-for-200-cases-with-rheumatoid-arthritis-psoriatic-arthritis-and-ankylosing-spondylitis-treated-by-tight-control-and-treat-to-target-strategy-permitting-dose-re/