To Compare the Cost of Rituximab and DCP Therapy in Pemphigus in a Government Tertiary Hospital

Abstract

Background: Pulsed corticosteroids are the mainstay in management of pemphigus but long term use is associated with numerous side effects. Biologics have shown promising results with minimal adverse effects but are expensive. Aim: To compare the cost of DCP & low-dose Rituximab therapy in pemphigus in a government tertiary hospital. Methods: We calculated the cost of DCP therapy (3 phases) and low dose Rituximab therapy in the treatment of pemphigus. These were considered under direct (medicines, usables for administering the medicines) and indirect costs (hospitalization, travel, loss of pay, the need for one attender) and a comparison were drawn. Results: The cost of DCP therapy for 3 phases over 27 months totalled up to 87,800 while the cost of Rituximab therapy over 1 month was 49,594. Low dose Rituximab therapy was clearly more cost effective. Limitations: We have not compared the efficacy of drugs, adverse effect profile or quality of life of patients in DCP and Rituximab group. Usables and steroids are free for patients in government hospital which partially reduces the cost of DCP further. Conclusion: Low dose Rituximab therapy has a high upfront cost but still proves to be very cost effective compared to DCP. Going by the published data on efficacy and safety of low dose Rituximab, it can provide better quality of life due to fast and sustained remission, drastically reduce the duration of hospital stay, reduced burden of the disease on the family and medical fraternity. It is time to switch to safer, cheaper and more effective remedies. Key messages: If the safety and efficacy of Rituximab can be clearly established, then it should be considered as a first line therapy for pemphigus.