DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20182098

A cost-effective analysis of various disease modifying anti-rheumatic drugs for patients with Rheumatoid Arthritis

Soniya Krishnan, Balan C. S., Seema P. Mohamedali

Abstract


Background: Rheumatoid Arthritis (RA) is a chronic disabling disorder that lowers quality of life in the affected patients. Early treatment with disease-modifying anti-rheumatic drugs (DMARDs, provides better control of disease and minimize joint destruction. Long term therapy imparts considerable economic burden to the patients. Cost effective analysis was performed among the patients treated with methotrexate (MTX) alone, hydroxychloroquine (HCQ) alone, and both (MTX+HCQ).

Methods: A prospective, observational study for six months to analyze the cost-effectiveness in RA patients with DMARDs-MTX, HCQ and MTX+HCQ. A total of 91 patients were included for analysis; 43 patients in MTX and HCQ group; 37 patients in MTX group and 11 patients in HCQ group. To assess the functional disability,” Stanford Health Assessment Questionnaire - Disability Index” (HAQ-DI) was administered. The patients were followed up for four months. The HAQ-DI at the baseline was compared with that of final follow up. The change in HAQ-DI and the total costs were used to find out the average cost- effective ratio (ACER).

Results: The least ACER was obtained for Hydroxychloroquine and highest was for Methotrexate. But there was no statistically significant difference in ACER between various treatment groups. There was no significant difference in the disease activity improvement between the three groups.

Conclusions: MTX, HCQ and MTX+HCQ showed improvement in disease activity without any significant difference. MTX is superior considering direct cost but there is no difference in the total cost between three groups.


Keywords


Average cost-effective ratio, Disease modifying anti-rheumatic drugs, Rheumatoid arthritis

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References


Mathew AJ, Antony J, Eremenco S, Paul BV, Jayakumar B, Philip J. Health-related quality of life in rheumatoid arthritis patients in South India. Singapore medical journal. 2009 Aug 1;50(8):800.

Cush JJ, Weinblatt ME, Kavanaugh A. Rheumatoid Arthritis: Early Diagnosis and Treatment. 2nd Edition, Professional Communications, 2008:324.

Maetzel A, Li LC, Pencharz J, Tomlinson G, Bombardier C, The Community Hypertension and Arthritis Project Study Team. The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis. 2004;63:395-401.

Finckh A, Bansback N, Marra CA, Anis AH, Michaud K, Lubin S, et al. Treatment of very early rheumatoid arthritis with symptomatic therapy, disease-modifying antirheumatic drugs, or biologic agents: a cost-effectiveness analysis. Annals of Internal Medicine. 2009 Nov 3;151(9):612-21.

National Institutes of Health. The health assessment questionnaire (HAQ) disability index (DI) of the clinical health assessment. Available at https://www.niehs.nih.gov/research/resources/assets/docs/haq_instructions_508.pdf.

Lillegraven S, Kvien TK. Measuring disability and quality of life in established rheumatoid arthritis. Clinical Rheumatology. 2007 Oct;21(5):827-40.

Bruce B, Fries JF. The Health Assessment Questionnaire (HAQ)Clin Exp Rheumatol. 2005;23(39):S14-8.

Sanchez LA. Pharmacoeconomics: principles, methods and applications. In: Di Piro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Michael Posey L, editor. Pharmacotherapy: a pathophysiologic approach. 6th Ed. USA: Mc Graw Hill; 2005:1-16.

HTA cost analysis methods. Available at: www.nlm.nih.gov › ... › NICHSR

Osiri M, Kamolratanakul P, Maetzel A, Tugwell P. Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthritis. Rheumatol Int. 2007; 27:1063-9.

Shini VK, Aboobacker S, Pahuja S, Revikumar KG, Bhasi R. Pharmacoeconomic study of DMARDs in the management of rheumatoid arthritis. International Journal of Pharmaceutical Sciences Review and Research. 2010; 5(3):148-54.

Revikumar KG, Miglani BD. Pharmacoeconomics and quality of life. In: Revikumar KG, Miglani BD. A text book of pharmacy practice. Ist ed. Maharashtra: Career publications; 2009:443-495.

Felson D, American College of Rheumatology Committee to Reevaluate Improvement Criteria. A proposed revision to the ACR20: the hybrid measure of American College of Rheumatology response. Arthritis Care & Research. 2007 Mar 15;57(2):193-202.

Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23:137-45.

Coons SJ. Health outcomes and quality of life. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Michael Posey L, editor. Pharmacotherapy: a pathophysiologic approach. 6th Ed. USA: Mc Graw Hill; 2005:17-26.

ACR. Classification Criteria for Determining Progression of Rheumatoid Arthritis. Available at: https://www.hopkinsarthritis.org/physician-corner/ed ucation/arthritis-education-diagnostic-guidelines/.

Michael MW. Clinical and Laboratory Measures. In: Haynes, Barton F, Pisetsky, David S and St. Clair, E. William. Rheumatoid arthritis. Lippincott Williams & Wilkins, Philadelphia;2004:54-58.

Zatarain E, Strand V. Monitoring disease activity of rheumatoid arthritis in clinical practice: contributions from clinical trials. Nature Reviews Rheumatology. 2006 Nov:611-618.

Schoels M, Wong J, Scott DL, Zink A, Richards P, Landewé R, et al. Economic aspects of treatment options in rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis. Annals of the rheumatic diseases. 2010 Jun 1;69(6):995-1003.

Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, et al. Good research practices for cost‐effectiveness analysis alongside clinical trials: the ISPOR RCT‐CEA task force report. Value in health. 2005 Sep 1;8(5):521-33.

Haynes, Barton F, Pisetsky, David S and St. Clair, E. William. Rheumatoid arthritis. Lippincott Williams & Wilkins, Philadelphia, 2004:55.

Osiri M, Maetzel A. The Economic burden of rheumatoid arthritis: Asia/Thailand perspective. In: Preedy VR, Watson RR eds, Handbook of disease burdens and quality of life measures. Springer; 2010:1733-1750.

Aletaha D, Strand V, Smolen JS, Ward MM. Treatment-related improvement in physical function varies with duration of rheumatoid arthritis: a pooled analysis of clinical trial results. Ann Rheum Dis. 2008;67:238-43.

Haroon N, Aggarwal A, Lawrence A, Agarwal V, Misra R. Impact of rheumatoid arthritis on quality of life. Modern Rheumatology. 2007 Aug;17(4):290-5.

McGhan WF. Pharmacoeconomics. In: Troy DB, editor. Remington: The science and practice of pharmacy. 21st Ed. USA: Lippincott Williams and Wilkins; 2006:2070-2081.

Sukhpreet, Agarwal V, Tiwari P. Treatment and monitoring costs in rheumatoid arthritis: Preliminary results from an Indian setting. Indian J Pharm Sci. 2007;69:226-31.

Ferraz MB, Pinheiro GR, Helfenstein M, Albuquerque E, Rezende C, Roimicher L, et al. Combination therapy with methotrexate and chloroquine in rheumatoid arthritis: A multicenter randomized placebo-controlled trial. Scandinavian J of Rheuma. 1994 Jan 1;23(5):231-6.

O'Dell JR, Haire CE, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, et al. Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. New England Journal of Medicine. 1996 May 16;334(20):1287-91.