SAT0565 COST EVOLUTION OF BIOLOGICAL AGENTS FOR THE TREATMENT OF RHEUMATOID ARTHRITIS IN A TERTIARY HOSPITAL INFLUENTIAL FACTORS IN PRICE
Authors: Mª Ángeles González-Fernández, Elena Villamañán Bueno, Inmaculada Jiménez-Nácher, Chamaida Plasencia, Alicia Herrero Ambrosio, Alejandro Balsa
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The availability of biological therapy has changed the approach to treating rheumatoid arthritis. Spending on biological agents has risen due to the drugs' high cost and the increased prevalence of rheumatoid arthritis. <h3>Objectives</h3> To evaluate the annual cost-per-patient and cost for each biological drug for in patients with rheumatoid arthritis from 2009 to 2017, and to calculate factors that affect at treatment cost, such as optimized therapies by monitoring drug serum levels, the use of biosimilars-TNF inhibitors, and discounts or negotiated rebates in biologicals acquired by pharmacy department. <h3>Methods</h3> Retrospective, observational study in a Spanish tertiary hospital. Main outcome: Annual cost-per-patient and per drug. Influential factors that affected the costs and demographic parameters and disease activity were also analyzed. <h3>Results</h3> A total of 320, 270, and 389 patients were treated in 2009, 2013, and 2017, respectively. Annual cost-per-patient decreased: €10,798 in 2009, €7491 in 2013 to €7116 in 2017. The introduction of new drugs drives economic competition leading to <i>total savings per drug</i>, with discounts reaching 24.6%, 15.5%, 11.5%, 17.8%, 17.9% and 21.1% for original infliximab, etanercept, adalimumab, certolizumab, golimumab and tocilizumab respectively, while rebates for biosimilar-infliximab reached 43.1% in 2017. Patients with optimized therapies reached 35.2% in 2017, which lead in cost savings of €1,288,535, in addition to savings from official discounts and rebates of €458,535 and savings from optimized therapies of €830,000 in 2017. Percentage of patients with optimized regimes for the study period increased from 4.6% in 2009, 51.5% in 2013 to 35.2% in 2017. Disease activity was lower annualy in the patient group with the optimized regimes <i>versus</i> the group without optimized regimes (p&lt;0,001). Biological drugs more optimized were infliximab, adalimumab etanercept, and tocilizumab reaching 57.1%, 55.3%, 39.8%, and 32.0%, patients respectively, in 2017. <h3>Conclusion</h3> The cost of biological treatments declined after official discounts, negotiated rebates, and optimized therapies, leading to a significant decrease in the annual cost per patient. The greatest contribution to economic savings in biological therapy according to our study was biological therapy optimization. <h3>References</h3> [1] González-Fernández M, Villamañán E, Jiménez-Nácher I, Moreno F, Plasencia C, Gaya F, et al. Cost evolution of biological agents for the treatment of spondyloarthritis in a tertiary hospital: influential factors in price. Int Jour Clin Phar 2018; 40:1528-1538. DOI:10.1007/s11096-018-0703-z [2] Plasencia C, Pascual-Salcedo D, García-Carazo S, Lojo L, Nuño L, Villalba A, et al. The immunogenicity the first anti-TNF therapy determines the outcome of switching to a second anti-TNF therapy in spondyloarthritis patients. Arthritis Res Ther. 2013; 15(4):R79. 3.. Pascual-Salcedo D, Plasencia C, Jurado T, Valle LG del, Sabina P, Diego C, et al. Dose-Tapering Of TNF Inhibitors in Daily Rheumatology Practice Enables the Maintenance of Clinical Efficacy While Improving Cost-Effectiveness. J Pharmacovigil 2015;3(4). <h3>Disclosure of Interests</h3> Mª Ángeles González-Fernández: None declared, Elena Villamañán Bueno: None declared, Inmaculada Jiménez-Nácher: None declared, Chamaida Plasencia: None declared, Alicia Herrero Ambrosio: None declared, Alejandro Balsa Grant/research support from: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Consultant for: Abbvie, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, Paid instructor for: Pfizer, Speakers bureau: Pfizer, Novartis, UCB, Nordic, Sanofi, Sandoz, Lilly