title: Economical impact associated with a biological therapy prioritization protocol in patients with rheumatoid arthritis in the Hospital of Sagunto.
abstract: BACKGROUND
  Until 2010 the cost of biological treatments in Rheumatoid Arthritis (RA) was increasing annually by 15% in our hospital. In 1st January 2011, a Hospital Commission of Biological Therapies involving rheumatology and pharmacy services was created to improve the management of biological drugs and a biological therapy prioritization protocol in RA patients was also established to improve the efficient usage of biological drugs in RA.
  
  
  OBJECTIVE
  To evaluate the economic impact associated with a biological therapy prioritization protocol for RA patients in the Hospital of Sagunto.
  
  
  METHODS
  Observational, ambispective study comparing the associated cost of RA patients treated with biological drugs in the pre-protocol (2009 - 2010) versus post-protocol periods (2011 - 2012). RA patients treated with Abatacept (ABA), Adalimumab (ADA), Etanercept (ETN) or Infliximab (IFX) for at least 6 months during the study period (2009 - 2012) were included. In 2012, Tocilizumab (TCZ) was also included in the prioritization protocol. Prioritization protocol was established based on both clinical and economical aspects and supervised case by case by our Commission. Cost savings and economic impact were calculated using Spanish official prices.
  
  
  RESULTS
  In the pre-protocol period (2009 - 2010), total expenses were increasing by €110,000, up to €1,761,000 in 2010 (€11,362 pat/year). After protocol implementation, total expenses decreased by 53,676€ on the 2010 - 2011 period, and 149,200€ on the 2011 - 2012 period. On the 2010 - 2011 period the cost of biological therapy per patient-year decreased 355€ (11,007€ pat/year) and additional 653€ (up to 10,354€ pat/year) by 2012, with a cumulative effect of the protocol implementation of 1,008€ per patient-year. In the pre-protocol period (2009), the annual cost/patient was 10.812€ with ETN, 10.942€ with IFX, 12.961€ with ADA and 12.739€ with ABA. By 1st January 2013, the annual cost per patient was 9,469€ with ETN, 10,579€ with IFX, 11,117€ with ADA, 13,540€ with ABA and 14,932€ with TCZ.
  
  
  CONCLUSIONS
  The creation of our Commission of Biological Therapies is key to rational management of RA patients and optimization of resources, allowing us to save 200,000€ after 2-year efficiency protocol implementation.
authors.affiliation: Pharmacy Service, Hospital de Sagunto , Avda Ramon y Cajal s/n Sagunto 46520, Valencia , Spain +34 962653809 ; +34 962659428 ; jborrasb@gmail.com.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Borrás-Blasco
authors.forename: M Dolores-Elvira
authors.initials: MD
authors.lastname: Casterá
authors.forename: Xavier
authors.initials: X
authors.lastname: Cortes
authors.forename: J Dolores
authors.initials: JD
authors.lastname: Rosique-Robles
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Abad
mesh_terms: D000069594:Abatacept; D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D001691:Biological Therapy / Q000191:economics*; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006292:Health Priorities / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D018796:Immunoconjugates / Q000191:economics / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D018796:Immunoconjugates; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069594:Abatacept; D000069285:Infliximab; D000068879:Adalimumab; C502936:tocilizumab; D000068800:Etanercept
keywords: TNF; biological therapies; economic impact; priorization; protocol; rheumatoid arthritis