PMS32 - Effectiveness and Costs of Conventional Dmard Therapy in Patients with Rheumatoid Arthritis

Abstract

Biological therapy for rheumatoid arthritis (RA) is still associated with high costs and has impacted the budget in the Colombian Health System in the last decade. We aimed to describe the costs and the effectiveness of conventional therapy in patients with RA using Disease Activity Score 28 (DAS28). During 12-month we followed patients with RA receiving conventional therapy, under a T2T model. Clinical follow-up was defined according to DAS28: every 3-5 weeks (DAS28>5.1), every 7-9 weeks (DAS28≥.1 and ≤5.1), and every 11-13 weeks (DAS28<3.1). 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 calculated for continuous variables and categorical variables were presented as percentages. We assessed the overall drug expenses using US Dollars at the official rate of exchange for December 2017. In a 12 month period 1310 patients were followed, 85% were women. Mean age was 60 ±11, mean DAS28 was 3.69 ±0.98. After 12 months we achieved remission in 42.2%, and LDA in 24.73% of our patients (at overall response of 67%). The most used medication was methotrexate 42%, followed by prednisone 18%, sulfasalazine 16%, chloroquine 10%, aziatropine 8% and leflunomide 7%. The costs for conventional DMARD therapy were USD $281.173, saving approximately for all patients USD$10.795.659 (mean biological therapy cost $8.458 per patient/year) through avoiding early use of biological therapy, using a T2T approach and patient multidisciplinary patient centered care (PCC) model. To achieve remission or LDA in patients with RA at a low cost is possible using conventional DMARDs and a PCC model. Other studies have shown the importance to establish clear criteria for the use of biological therapy in order to use it with economic rationality.