PMS41 - The Impact of Biologic Therapy Versus Conventional Treatment on The Costs of Ankylosing Spondylitis Chronic Complications Under The Perspective of Brazilian Private Health Care System

Abstract

Ankylosing spondylitis (AS) is a form of spondyloarthritis with chronic inflammatory involvement of axial skeleton, variable peripheral joints and nonarticular structures. The objective of this study was to determine the costs comparing patients under biologic therapy (BT) with those in conventional treatment (CT), under Brazilian private health care system’s perspective. We studied 6.5 million members of a proprietary claim database, from January 2009 to December 2012. Approximately 0.04% (2,626) was patients with ICD-10 AS-related. Most of them were from private health care plans. All medical out-patients and in-patients treatment costs were studied, including drugs and ancillary diagnostic tests. The females comprise 52% of this cohort, and 73.8% of them were between 18 and 49 years old. Around 2,626 patients were treated, being 2,492 with CT and 134 with BT, primarily anti-TNF therapy.About 74% treated with CT presented any comorbidity, while 0.75% of those treated with BT. The total costs were USD3,668 for CT and USD4,575 for BT, with mean patient costs of USD1,980 for CT and USD4,575 for BT. The average hospitalizations costs for comorbidities were USD1,106, stressing that many of them were gastrointestinal complications of the disease. The average hospitalization costs under CT was USD7,988, considering under BT was USD1,271. The average days of hospitalization were 4.83 and 3.1 days for CT and BT, respectively. The total costs of hospitalization of CT was USD511,217 being 62% due to materials (e.g., prosthesis) and USD25,428 for BT, being 17% due to materials and 66% due to room rates and equipment rental. In this Brazilian private claim database, BT had lower direct costs for hospitalizations and probability of comorbidities, when compared to CT. Although the mean patient cost with BT is higher than with CT, the lower probability of comorbidities occurrence with BT may justify its choice.