Machado-Alba Jorge Enrique, Machado-Duque Manuel E, Gaviria-Mendoza Andres, Reyes Juan Manuel, Gamboa Natalia Castaño
Grupo de Investigación de Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira - Audifarma SA, Pereira, Colombia, 660003.
Grupo Biomedicina, Facultad de Medicina, Fundación Universitaria Autonoma de las Américas, Pereira, Colombia.
Clin Rheumatol. 2021 Apr;40(4):1273-1281. doi: 10.1007/s10067-020-05432-6. Epub 2020 Sep 30.
INTRODUCTION/OBJECTIVES: The objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib.
This is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider.
We evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4-17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377.
In the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs. Key Points • Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs. • The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission. • Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.
引言/目的：本研究的目的是描述一组接受生物改善病情抗风湿药物（bDMARDs）或托法替布治疗的哥伦比亚类风湿关节炎（RA）患者的治疗模式及医疗资源使用情况。
这是一项描述性研究，来自一个回顾性队列，该队列中的患者被诊断为RA，在传统改善病情抗风湿药物（cDMARDs）或首个bDMARD治疗失败后接受bDMARDs或托法替布治疗。纳入了2014年1月1日至2018年6月30日期间接受药物治疗的患者。通过审查索赔数据库和电子病历进行分析。收集了人口统计学和临床数据。医疗资源成本根据医疗服务提供者的计费费用估算。
我们评估了588例接受bDMARDs（n = 505）或托法替布（n = 83）治疗的RA患者，其中大多数患者联合使用了cDMARDs（85.4%）。88.1%为女性，平均年龄为57.3±12.5岁。自诊断以来RA的中位病程为9年（四分位间距：4 - 17.2年）。bDMARDs或托法替布随访期间的平均使用时长相似，平均为9.8±1.9个月。经确认，394例（67.0%）患者停止治疗。每位患者每年的平均直接护理成本为8997±2172美元，其中97.2%归因于药物成本。每位使用bDMARDs的患者每年的平均治疗成本为8604美元，使用托法替布的患者为6377美元。
面对cDMARD首次治疗失败时，常加用bDMARDs。在随访的第一年，有很高比例的患者未坚持治疗。药物治疗是医疗成本最具代表性的原因。要点•类风湿关节炎是一种合并症、并发症负担高、健康相关生活质量较差且医疗成本升高的疾病。•生物改善病情抗风湿药物或托法替布适用于疾病有显著进展以及需要替代方案以实现低疾病活动度和缓解的患者。•接受生物改善病情抗风湿药物或托法替布治疗的类风湿关节炎患者给卫生系统带来了巨大的经济负担，尤其是在药物治疗产生的成本方面。
