Impact of medical practices on the costs of management of rheumatoid arthritis by anti-TNFalpha biological therapy in France.
When the anti-TNFalpha drugs first came onto the market, their high price was the subject of much debate. Moreover, we must add the costs associated with their administration to the purchase price. Variations in medical practices may be the source of substantial variations in these costs.


OBJECTIVE
To compare the costs involved with the use of infliximab and etanercept in the treatment of rheumatoid arthritis (RA) and to study the impact of variations in medical practices on them.


METHODS
A pragmatic cost minimization analysis was conducted from the payer's perspective to compare the costs of administration, that is, the direct medical costs, of the first two available anti-TNFalpha agents: infliximab and etanercept. Records of 60 patients from three university hospital rheumatology departments were reviewed retrospectively for a 52-week period. This analysis considered the following costs: purchase costs for the drugs and for any co-prescribed disease-modifying drugs, inpatient or outpatient administration, medical follow-up and the transportation costs associated with treatment that were reimbursed by the French health insurance system. Costs that did not differ between the two products were excluded (work-up for inclusion, etc.).


RESULTS
Data were collected for 58 patients, 30 treated with infliximab and 28 with etanercept. Patients' mean age was 52 years; 81% were women. RA had first developed on average 15 years earlier; the disease was positive for rheumatoid factors in 68% of cases and erosive in 93%. The total average annual cost of administration did not differ for infliximab and etanercept: 19,469 and 19,619 , respectively (P=0.56). The mean costs of administration nonetheless varied considerably between the three hospital centers: from 16,566 to 24,313 for infliximab (P<0.0001) and from 16,069 to 24,383 for etanercept (P<0.0001).


CONCLUSIONS
The financial burden of biological treatments for RA is strongly influenced by the substantial heterogeneity in medical practices.
Department of Rheumatology, Groupe Hospitalier Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75651 Paris cedex 13, France. bruno.fautrel@psl.ap-hop-paris.fr
Bruno
B
Fautrel
Marie-Christine
MC
Woronoff-Lemsi
Morgane
M
Ethgen
Estelle
E
Fein
Pierre
P
Monnet
Jean
J
Sibilia
Daniel
D
Wendling
D000328:Adult; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000628:therapy*; D017281:Cost of Illness; D016527:Drug Costs; D000068800:Etanercept; D005260:Female; D005602:France; D017048:Health Care Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics* / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000191:economics*
D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept