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Title: Cost-effectiveness of drugs which suppress the rheumatic disease process
Authors: Coleiro, Bernard
Keywords: Rheumatoid arthritis
Drugs -- Malta
Medical economics
Issue Date: 2009
Citation: Coleiro, B. (2009). Cost- effectiveness of drugs which suppress the rheumatic disease process (Master's dissertation).
Abstract: Rheumatoid arthritis is a chronic, progressive, debilitating, inflammatory disease affecting predominantly the synovial joints of the body. If left unchecked it causes considerable pain, deformity and disability which in turn result in impairment of the psychological and social functioning of the patient. All this imposes an economic burden on the patient as well as on the state. Prior to the 1990s the treatment of rheumatoid arthritis consisted of disease-modifying antirheumatic drugs (DMARDs), steroids and analgesics which are not so expensive and did not contribute a large percentage to the overall cost of treating rheumatoid arthritis. More recently tumour necrosis factor (TNF) inhibitors have been added to the armamentarium of treatment of rheumatoid arthritis. These agents are considerably more expensive than what was available before so this study was undertaken to explore their cost effectiveness ratio. Ten patients who satisfied the American College of Rheumatology (ACR) criteria for a diagnosis of rheumatoid arthritis and who, during the study period, still experienced active joint disease despite full doses of traditional disease-modifying antirheumatic drugs, were commenced on tumour necrosis factor inhibitor therapy and formed the basis of this study. In view of the expense of this treatment it was important to demonstrate a beneficial effect both from the physician's perspective as well as from the patient's. Outcome measures were selected to cover both these aspects and consisted of the disease activity score (DAS28) as a predominantly objective marker of disease activity as well as the Health Assessment Questionnaire (HAQ) and the Short Form -36 (SF36) as subjective markers of functional disability. Statistically significant improvements in all these outcome measures were noted as early as 6 months after the start of tumour necrosis factor inhibitor blocker therapy and this was sustained at the end of 1 year. A statistically significant correlation was also noted between the outcome measures DAS28 and HAQ over time. The pharmacoeconomic analysis was based on calculating the incremental cost effectiveness ratio (lCER) per unit of improvement in the Health Assessment Questionnaire score and per unit of improvement in the disease activity score (DAS28). An incremental cost effectiveness ratio of € 9,523 / unit of Health Assessment Questionnaire and of € 4,427 / unit of DAS28 was obtained taking into consideration direct costs. If indirect costs were to be included in the equation, a more favourable incremental cost effectiveness ratio was obtained: € 3,037 / unit of Health Assessment Questionnaire and of € 1275/ unit ofDAS28 when calculated from the Government's perspective and € 77 / unit of Health Assessment Questionnaire and of € 32 / unit of disease activity score (DAS28) when calculated from the patient's perspective. How cost-effective the tumour necrosis factor inhibitors are will ultimately depend on how much the health care system is prepared to spend to achieve the significant improvement in the outcome measures observed in this study bearing in mind that this improvement may well translate into economic benefits due to reduced loss of work productivity and possibly a reduced need for institutional care. These benefits may offset a significant part of the increased expense of the tumour necrosis factor inhibitors.
Description: M.PHIL.
Appears in Collections:Dissertations - FacM&SPha - 2009

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