[Financial cost of early rheumatoid arthritis in the first year of medical attention: three clinical scenarios in a third-tier university hospital in Colombia].
BACKGROUND
In Colombia, the cost burden of chronic diseases is not well known, either globally or in localized areas of the health system. Rheumatoid arthritis is one of most common chronic diseases, and represents a high cost for the health system.


OBJECTIVE
The direct medical costs were estimated for rheumatoid arthritis patients in the in the first year of diagnosis at a level 3 university hospital in Colombia.


METHODS
Three therapy settings for early rheumatoid arthritis patients were established in the first year of diagnosis according to national and international guidelines. Each setting included treatment with disease-modifying anti-rheumatic drugs or biologic therapy based on disease severity as measured by Disease Activity Score 28. All direct medical costs were included: specialized medical care, diagnostic tests and drugs. Cost information was obtained from the Central Military Hospital finance department in Bogotá and the national manual of drug prices based on the "Farmaprecios" 2007 guide, a reference in general use by health institutions. Results. The average of cost of medical care in patients with mild, moderate and severe disease was US $1689, $1805 and $23,441 respectively. The recommended retail prices of the medicines published in "Farmaprecios" was US $1418, $1821 and $31,931. When the charges levied by several major health institutions were compared, substantial increases were noted, US $4936, $7716 and $123,661, respectively. Drug costs represented 86% of total cost, laboratory costs were 10% and medical attention was only 4%.


CONCLUSIONS
Drugs costs were the principal component of the total direct medical cost, and it increased 40 times when a biological therapy is used. Complete economic evaluation studies are necesary to estimate the viability and clinical relevance of biological therapy for early rheumatoid arthritis.
Mora
Claudia
C
Servicio de Reumatología, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, D.C., Colombia.
González
Andrés
A
Díaz
Jorge
J
Quintana
Gerardo
G
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D002985:Clinical Protocols; D003105:Colombia; D003954:Diagnostic Services / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data; D019468:Disease Management; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D000068800:Etanercept; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D000069285:Infliximab; D007555:Isoxazoles / Q000191:economics / Q000627:therapeutic use; D000077339:Leflunomide; D000077239:Meloxicam; D008727:Methotrexate / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012460:Sulfasalazine / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013843:Thiazines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013844:Thiazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007555:Isoxazoles; D018124:Receptors, Tumor Necrosis Factor; D013843:Thiazines; D013844:Thiazoles; D012460:Sulfasalazine; D006886:Hydroxychloroquine; D000069285:Infliximab; D000068879:Adalimumab; D000077339:Leflunomide; D000068800:Etanercept; D000077239:Meloxicam; D008727:Methotrexate