AB1475-HPR Cost evolution of biological agents for the treatment of spondyloarthritis in a spanish tertiary hospital: influential factors in price development
Authors: E. Villamañan Bueno, I. Jiménez Nácher, F. Moreno Ramos, A. Herrero Ambrosio, C. Plasencia Rodríguez, A. Balsa
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Spending on biological agents has risen dramatically in Spanish hospitals due to the drugs' high cost and the increased prevalence of spondyloarthritis. <h3>Objectives</h3> To calculate and compare the annual cost per patient with spondyloarthritis and for each biological drug according to clinical practice from 2009 to 2016 and to analyse the factors that influence consumer pricing, such as biological therapy optimisation (by monitoring drug and anti-drug antibody serum levels), the use of tumour necrosis factor inhibitor biosimilars, and drug discounts, refunds, and rebates. <h3>Methods</h3> We conducted a retrospective observational study that analysed patient demographic parameters, disease activity, and annual cost per patient and per drug and determined the economic factors that affected on consumer pricing. <h3>Results</h3> A total of 129, 215, and 224 patients were treated in 2009, 2013, and 2016, respectively; 77 (59.69%), 133 (61.86%) and 139 (62.05%), respectively, were men aged 46.04 (±12.57), 47.76 (±12.35) and 48.27 (±13.49) years, respectively. Nonstatistically significant differences were observed. The annual cost per patient decreased during the study period (from €11.604 in 2009, €8.513 to €7.464 in 2016). There was an increase in the number of marketed biological drugs and in the total savings per drug, with discounts and bonus units in 2016 reaching 12%–18% for etanercept, adalimumab, certolizumab, and golimumab and up to 25% for the recently released secukinumab, while rebates for biosimilar infliximab reached 69% in 2016. Biological therapy optimisation reached 47.5% in 2016, which resulted in cost savings of 23.89%, in addition to the savings from refunds and rebates (11.06%) in 2016. <h3>Conclusions</h3> The resulting treatments after the rebates, invoice discounts, and optimizations were more cost-effective, leading to a significant decrease in the annual cost per patient and an overall reduction in expenditure for these drugs. <h3>References</h3> [1] Guía de Práctica Clínica para el Tratamiento de la Espondiloartritis Axial y la Artritis Psoriásica. Available at https://www.ser.es/wp-content/uploads/2016/04/GPC_-Tratamiento_EspAax_APs_DEF.pdf [2] Informe técnico ANTI-TNF – reumatologia.pdf [Internet]. [cited June21,2017]. Available at http://sescam.castillalamancha.es/sites/sescam.castillalamancha.es/files/documentos/farmacia/reumatologia.pdf [3] Real Decreto-ley 4/2010, de 26 de marzo, de racionalización del gasto farmacéutico con cargo al Sistema Nacional de Salud. BOE.es [4] 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;3(4). [5] Guidelines on evaluation of similar biotherapeutic products (SBPs). Available at: http://www.who.int/biologicals/publications/trs/areas/biological_therapeutics/Guidelines_Biotherapeutic_products_FINAL_HK_IK_12_June.pdf <h3>Acknowledgements</h3> We would like to thank the staff in the Departments of Pharmacy and Rheumatology. In particular we would also like to thank Francisco Gayá from the Department of Biostatistics and Dr. Pascual-Salcedo from the Department Immunology. <h3>Disclosure of Interest</h3> None declared