The aim of this study was to carry out retrospective comparison of two rheumatoid arthritis treatment schemes in terms of their costs and effectiveness with biological drugs: infliximab and etanercept.
Material and methods: The data used for the pharmacoeconomic analysis was taken from the history of treatment of 70 patients treated in the Department of Clinical Rheumatology and Connective Tissue Diseases at the Second University Hospital in Bydgoszcz. The retrospective analysis included only the direct medical costs. The results were obtained by comparing the difference between DAS28 value before the treatment and 24 months after the treatment start, or when the remission of illness occurred. Sensitivity analysis was carried out in accordance with the Good Pharmacoeconomic Practice Guide, checking the influence of change of key parameters on the results of the analysis.
Results: The results showed that the cheaper and more effective method of treatment was the one in which etanercept was used. The average cost of treatment of one patient with etanercept was 62,876.78 zł and with infliximab was 66,361.03 zł. The clinical response after the use of etanercept was defined by a greater decrease in DAS28 of 3.38, as opposed to the clinical response after the use of infliximab which was defined by a decrease in DAS28 of 3.11. Biological drugs constituted the greatest percentage of the overall costs of both the infliximab (86.02%) and the etanercept (97.3%) treatment scheme. Hospitalization costs constituted 11.38% of the total cost of treatment with infliximab. Since treatment with etanercept is an outpatient treatment, there were no hospitalization costs in the total cost of this treatment scheme. Both the costs of diagnostic tests (1365.63 zł) and of other drugs (293.63 zł) in the infliximab treatment scheme were higher than those of diagnostic tests and other drugs in the etanercept treatment scheme: 809.37 zł and 176.07 zł respectively. The costs of medical examination were higher in the etanercept treatment scheme (713 zł) than in the infliximab treatment scheme (69.19 zł) (Tables I, II). According to the sensitivity analysis, there were no significant changes within the 10% range of the basis case (Table III).
Conclusion: From the pharmacoeconomic point of view, the etanercept treatment scheme dominates over the infliximab treatment scheme, because it is cheaper and from the clinical point of view more effective.