Aim of the study: This paper presents a retrospective analysis of costs and treatment results of patients with active rheumatoid arthritis (RA) treated with leflunomide (LEF) and subcutaneous (s.c.) methotrexate (MTX).
Material and methods: The research material was collected from the records of 111 RA patients with active RA. The patients were treated on an outpatient basis at the Clinical Department of Rheumatology and Connective Tissue Diseases Hospital University Number 2 in Bydgoszcz. The drugs were used in monotherapy. Fifty-one patients were treated with MTX s.c. and 60 with LEF p.o. This paper analyses direct medical costs of diagnostic and medical examinations, consultations, LEF and MTX s.c. purchase, as well as the purchase of support drugs, drugs used in flare of RA and drugs used to prevent and treat complications. As the European League Against Rheumatism (EULAR) guidelines suggest, the DAS28 index was used to evaluate the effectiveness of treatment. Cost-effectiveness analysis was used in the study.
Results: More effective but also more expensive is the LEF treatment.
The average cost of 6-month treatment of 1 patient is 2922.59 PLN, which allowed DAS28 to be reduced by 25.15%. The average cost of treatment with MTX s.c. was estimated at 1582.01 PLN with the reduce of DAS28 value to 22.96%. The incremental analysis shows that the cost of obtaining one additional unit of DAS28 in the course of 6 months of therapy is 26 811.60 PLN per patient. The highest share in the total cost of drugs purchase corresponds to disease-modifying antirheumatic drugs (DMARDs). The average cost of LEF treatment was 2276.22 PLN and for the MTX s.c. treatment was 965.03 PLN per patient. Diagnostic costs in the LEF treatment were slightly higher. The costs of medical examinations and consultations were the same in both treatments. The costs of support drugs and drugs used to prevent and treat complications are low.
Conclusions: Of the two compared methods of treatment, which are considered to be the first or second-line therapies, the use of LEF is more effective but also almost twice as expensive. Considering the current price of leflunomide, it does not offer an economically attractive alternative.