Cost-effective analysis of disease-modifying anti-rheumatic drugs in rheumatoid arthritis

Abstract

The main objective of the study was to perform the pharmacoeconomic analysis of synthetic disease-modifying anti-rheumatic drugs in rheumatoid arthritis patients. A prospective, observational study was conducted in 98 rheumatoid arthritis (RA) patients meeting 2010 Rheumatoid Arthritis Classification Criteria. Treatment-naive RA patients were initiated on synthetic disease-modifying anti-rheumatic drugs (DMARD/s) and followed up for 3 months. Average cost-effectiveness analysis was done by taking Health Assessment Questionnaire Disability Index (HAQ-DI) score as a measure of effectiveness. Out of the 98 RA patients, 15.30% were males and 84.69% females. 80.61% RA patients are seropositive. Majority of the study population patients (55%) were on combination of three synthetic DMARDs and almost a quarter (24.48%) were on combination of two synthetic DMARDs. The mean value of DAS 28 at baseline was 6.07 ± 1.33 and after 3 months treatment, the mean was 3.84 ± 1.11. The mean disability index measured by HAQ-DI was significantly reduced from 1.43 ± 0.71 to 0.81 ± 0.61, p < 0.001, after 3 months treatment. The direct medical cost of treatment of RA per month is 997.05 rupees. The average cost-effectiveness ratio of combination of synthetic DMARDs was 1533.92 rupees. Treatment of RA with synthetic DMARDs controls disease activity and improves disability with reasonable cost of treatment. The majority of the direct medical cost is attributable to cost of medicine and laboratory investigation. Use of quality generic drugs and an early diagnosis would minimize the economic burden on the patient.

Use of healthcare resources in a cohort of rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs or tofacitinib

“…The relationship between the high costs of pharmacological treatment of RA patients and the lack of persistence or adherence throughout follow-up demonstrates the difficulties that health systems have in covering this pathology, especially in developing countries, which have limited resources and which need to select cost-effective therapies based on their own analysis that guarantee access and coverage that are also safe and improve the quality of life of those who require them [38,39]. Undoubtedly, the problems of lack of persistence in the use of antirheumatic drugs deserve special attention, which leads to the need to search for strategies that identify the causes and improve adherence to treatment.…”

Evaluation of prescription practices in rheumatoid arthritis at the rheumatology clinic in a tertiary care teaching hospital in Uttarakhand

“…Various other studies conducted in different settings have reported similar female predominance in their study varying between 76.7% and 87%. [ 4 5 6 7 8 ] The reasons for this feminine predominance in auto-immune diseases are not clear, though genetic (X-linked) factors and hormonal relation have been attributed. [ 9 10 ] In the present study, the median age was 48 years which was comparable to other studies which showed that the peak prevalence of RA was in fifth decade.…”

“…[ 9 10 ] In the present study, the median age was 48 years which was comparable to other studies which showed that the peak prevalence of RA was in fifth decade. [ 4 6 11 12 ]…”

“…The preferred DMARD in our study was MTX, prescribed in all the patients, either alone or in combination, consistent with other studies which also report it as the most preferred agent. [ 4 6 ] According to the ACR 2020 guidelines, it is recommended that MTX monotherapy should be the first treatment of choice for patients with DMARD-naïve RA with low, moderate or high disease activity. [ 19 ] In contrast to our study where the majority (73.3%) received MTX monotherapy, most other studies have reported two DMARD combination as the most frequently used regimen to manage RA.…”

“…[ 21 ] Various other studies have reported combinations of three conventional synthetic DMARDs as the most commonly used regimen. [ 4 6 ] The variation in number of DMARDs prescribed might be due to the varied severity of disease encountered in different hospital settings.…”