PMS9 - Cost-Savings Due To Implementation of A Screening Algorithm For Diagnosis of Rheumatoid Arthirits in Colombia

Abstract

The lack of expertise in diagnosis of rheumatoid arthritis (RA) at primary level centers becomes in misdiagnosis of this condition. We implemented in Colombia at a specialized center in RA a diagnosis algorithm to achieve a correct and definitive diagnosis.The aim of this study was to describe the examination model and to find the proportion of patients with a correct diagnosis of RA when an algorithm of disease diagnosis was applied and the costs-savings associated with the accurate diagnosis of this disease. A descriptive study included patients who were referred from primary care centers with presumptive diagnosis of RA. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including physical examination and joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about diagnosis was requested a comparative MRI or ultrasound of hands or/and feet. Between 2011 and 2016 10.716 patients were studied. With our screening model we found 46% (4.944) patients had RA and 54% (5.772) had other rheumatic diseases mainly osteoarthritis, Sjögren syndrome, systemic lupus erythematosus among others. When we calculated cost savings related to the adequate diagnosis of RA we saved in medications, medical services and diagnostic control tests per patient 1.254 USD every year and for the 5.772 patients we saved 3.591.000 USD/million dollars during a five year period. The results of this study are evidence to support the urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA in order to conduct a proper diagnose of RA and to avoid impact on health system budget