Comparative analysis of the cost of pharmacotherapy schemes for patients with rheumatoid arthritis
Rheumatoid arthritis (RA) is an unpredictable and progressive inflammatory disease of the joints of an immune nature, which in general for various reasons reduces the life expectancy of patients by 5 to 10 years. Pharmacotherapy of RA is based on long-term use of a large number of drugs of different pharmacotherapeutic groups, the cost of which varies significantly. The above makes the study of economic parameters of RA treatment an urgent problem.
The aim of the study was to analyse the cost characteristics of pharmacotherapy of inpatients with RA in a hospital in order to optimize the cost of medication for these patients.
The data of medical cards and medical records of 89 and 108 inpatients with RA, which were treated in the rheumatology department of the 4th Lviv City Clinical Hospital in 2009 and 2019, respectively, were selected as objects of the study. The methods of information retrieval, mathematical statistics, frequency, comparative, content analysis, data generalization, cost analysis were used.
Disease-modifying antirheumatic drugs (DMARDs), glucocorticosteroids (GCs), and nonsteroidal anti-inflammatory drugs (NSAIDs) were grouped into six schemes for the RA pharmacotherapy in 2009 and 2019. An increase in the number of appointments of those schemes in which DMARDs were used has been established. The maximum share in both analysed periods was occupied by the triple pharmacotherapy scheme, which included all the above-mentioned drugs. This scheme was also the most expensive and its value at average retail prices (ARP) increased the most (9.4 times) from 2009 till 2019. During the analysed period, the average salary in Lviv region increased in 5.4 times, while the cost change indices (Ic) of different pharmacotherapy schemes, calculated on the basis of ARP, ranged from 6.9 for the two-component scheme with DMARDs and NSAIDs to 9.4 for the three-component scheme with DMARDs, GCs and NSAIDs. The analysis of affordability indices (Ia) showed that the most accessible was a two-component scheme, which included DMARDs and NSAIDs (Ia = 0.78). The study of the influence of the cost of the treatment schemes on the frequency of their prescribing using correlation analysis showed a very high dependence of these indices (R = 0.97). Pairwise correlations of pharmacotherapy appointment change indices (Iap) from Ic based on minimum (RPmin), maximum (RPmax) or average retail prices in Lviv pharmacies made it possible to establish a very high pair dependence of Iap from Ic calculated only on the basis of RPmax or ARP (R = 0.90).
Thus, the analysis of patients' consumption of drugs for pharmacotherapy RA in the hospital allowed us to establish that in 2019 the treatment of RA became less available in comparison to 2009.
Ponyk R. M., Korytko Z. I. Disease and peculiarities of rehabilitation of patients with rheumatoid arthritis in the present time // Zdobutky klin. ta eksperym. med. – 2019. – № 3. – S. 183–187. https://doi.org/10.11603/1811-2471.2019.v.i3.10504
Kuznetsov I. E. Results of the ABC-, VEN-and frequency analysis of pharmacotherapy of the rheumatoid arthritis in a health care facility // Upravlinnya, ekonom. zabezpech. yakosti v farm. – 2015. – № 2 (40). – S. 64–68. URL: http://dspace.n11uph.edu.ua/handle/123456789/87
Hrytsenko O. D., Shesternya P. A. Pharmacoeconomic analysis of the initial treatment of rheumatoid arthritis with tumour necrosis factor inhibitors // Profylakt. i klin. meditstyna. – 2020. – № 1. – S. 64–71. URL: https://elibrary.ru/item.asp?id=42631747
Okonenko T. Y., Khrutskyy A. K., Okonenko L. B., Ehorova E. S. Pharmacoeconomic analysis of the treatment of the rheumatoid arthritis of the early stage and the most frequent comorbid conditions // Sarat. nauch.-med. zhurn. – 2017. – T. 13. – № 3. – S. 462–468. URL: https://cyberleninka.ru/article/n/farmakoekonomicheskiy-analiz-lecheniya-revmatoidnogo-artrita-ranney-stadii-i-naibolee-chasto-vstrechayuschihsya-komorbidnyh/viewer
Behmurod B. S., Saydov Е. U., Makhmudov Kh. R. Clinical and pharmacoeconomic aspects of active controlled anti-inflammatory therapy of rheumatoid arthritis, based on the principles of the «treat-to-target» strategy: current state of the issue // Vestn. Avytsenny. – 2019. – № 21 (1). – S. 141–146. https://doi.org/10.25005/2074-0581-2019-21-1-141-146
Joensuu J. T., Huoponen S., Aaltonen K. J. et al. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review // PloS one. – 2015. – N 10 (3). – P 1–27. https://doi.org/10.1371/journal.pone.0119683
Martelli L., Olivera P., Roblin X. et al. Cost-effectiveness of drug monitoring of anti-TNF therapy in inflammatory bowel disease and rheumatoid arthritis: a systematic review // J. gastroenterol. – 2017. – N 52 (1). – Р. 19–25. https://doi.org/10.1007/s00535-016-1266-1
Bansback N., Phibbs C. S., Sun H. et al. Triple therapy versus biologic therapy for active rheumatoid arthritis: a cost-effectiveness analysis // Annals of internal medicine. – 2017. – N 167 (1). – Р. 8–16. https://doi.org/10.7326/M16-0713.
Wailoo A., Hock E. S., Stevenson M. et al. The clinical effectiveness and cost-effectiveness of treat-to-target strategies in rheumatoid arthritis: a systematic review and cost-effectiveness analysis // Health Technology Assessment. – 2017. – N 21 (71). – 258 p. https://doi.org/10.3310/hta21710
Jansen J. P., Incert D., Mutebi A. et al. Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators // J. Medical Economics. – 2017. – N 20 (7). – Р. 703–714. https://doi.org/10.1080/13696998.2017.1307205
Verschueren P., De Cock D., Corluy L. et al. Effectiveness of methotrexate with step-down glucocorticoid remission induction (COBRA Slim) versus other intensive treatment strategies for early rheumatoid arthritis in a treat-to-target approach: 1-year results of CareRA, a randomised pragmatic open-label superiority trial // Ann. Rheum. Dis. – 2017. – N 76 (3). – Р. 511–520. http://dx.doi.org/10.1136/annrheumdis-2016-209212
Verhoef L. M., Tweehuysen L., Hulscher M. E. et al. bDMARD dose reduction in rheumatoid arthritis: a narrative review with systematic literature search // Rheumatol. Ther. – 2017. – N 4 (1). – Р. 1–24. https://doi.org/10.1007/s40744-017-0055-5
Prices for medicines and medical products. URL: https://www.apteka.ua/ceny-na-lekarstvennye-sredstva-i-izdeliya-mednaznacheniya
Tabletki.ua – search and booking of drugs in pharmacies, instructions for use. URL: https://tabletki.ua/uk/
Nemchenko A. Halyy L. Pharmacoeconomics: methods of monitoring prices and determining the level of availability of medicines in Ukraine // Liky Ukrayiny. – 2001. – № 5. – P. 21–26.
Ministry of Finance. Average salary 2019. URL: https://index.minfin.com.ua/ua/labour/salary/average/2019/
Ministry of Finance. Average salary 2009. URL: http://www.ukrstat.gov.ua/operativ/operativ2009/gdn/reg_zp_m/reg_zpm09_u.htm
Order of the Ministry of Health of Ukraine dated October 13, 2006 No 676 «On approving the protocols for medical care in specialty “Rheumatology”». URL: https://zakon.rada.gov.ua/rada/show/v0676282-06/ed20061012#Text
Order of the Ministry of Health of Ukraine dated April 11, 2014 No 263 «On introduction of medical and technological documents on standardization of medical care at rheumatoid arthritis». URL: https://zakon.rada.gov.ua/rada/show/v0263282-14#Text
This work is licensed under a Creative Commons Attribution 4.0 International License.