title: Dealing with the high cost of biological therapies: developing and implementing a biological therapy prioritization protocol for ankylosing spondylitis patients in a tertiary hospital.
abstract: OBJECTIVE
  In January 2011, a biological therapies commission was created in our hospital to fully address the management of biological drugs. A biological therapy prioritization protocol was developed for ankylosing spondylitis (AS) patients. Here, we describe it and report on its economic impact to illustrate how we are optimizing the use of these expensive new drugs.
  
  
  METHODS
  The biological therapies commission established several procedures for the rational use of biological drugs such as cost-efficiency therapeutic protocols, pharmacovigilance, and therapeutic drug monitoring programs. The AS protocol was based on clinical and economic aspects. We estimated the economic impact of the protocol by comparing the cost of treating AS patients with biological drugs in the pre-commission (2009 - 2010) vs. post-commission period (2011 - 2013). AS patients treated with adalimumab (ADA), etanercept (ETN) or infliximab (IFX) for at least 6 months in the 2009 - 2013 period were included.
  
  
  RESULTS
  107 patients were included. In the pre-commission period, total expenses increased by +30,944 Euro (+4%). After protocol implementation, total expenses decreased by 11,441 Euro (-1%) during 2011, and by an additional 36,781 Euro (-4%) and 53,872 Euro (-8%) in 2012 and 2013, respectively. In the 2010 - 2013 period the cost of biological therapy per patient-year decreased by 869Â â¬, suggesting the positive effects of the biological therapy prioritization protocol instauration.
  
  
  CONCLUSIONS
  We describe the establishment of a multidisciplinary biological therapy commission to optimize the use of biological therapies. We illustrate its work in developing a protocol for the management of AS patients with such therapies. We show that after 3-years of implementation, the biological therapy prioritization protocol allowed us to steadily decrease the direct cost of biological drug therapies per patient, up to 869 Euro.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Borrás-Blasco
authors.forename: Elvira
authors.initials: E
authors.lastname: Casterá
authors.forename: Xavier
authors.initials: X
authors.lastname: Cortes
authors.forename: Juan
authors.initials: J
authors.lastname: Martín-Alonso
authors.forename: J Dolores
authors.initials: JD
authors.lastname: Rosique-Robles
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Abad
mesh_terms: D000328:Adult; D000368:Aged; D001691:Biological Therapy / Q000191:economics*; D002985:Clinical Protocols; D005260:Female; D017048:Health Care Costs; D006292:Health Priorities; D006801:Humans; D008297:Male; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000628:therapy*; D062606:Tertiary Care Centers