1
|
Santos-Moreno P, Alvis-Zakzuk NJ, Villarreal-Peralta L, Carrasquilla-Sotomayor M, de la Hoz-Restrepo F, Alvis-Guzmán N. Centers of Excellence Implementation for Treating Rheumatoid Arthritis in Colombia: A Cost-Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:583-591. [PMID: 34188503 PMCID: PMC8236254 DOI: 10.2147/ceor.s308024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Health systems need to optimize the use of resources, especially in high-cost diseases as rheumatoid arthritis (RA). We aimed to evaluate the efficiency of using centers of excellence (CoE) as a strategy for improving RA treatment in Colombia. Methods A cost description analysis was carried out using the standard costing technique. We estimated the costs of medical consultations, laboratories, images, and medications for RA. Categories of care standards stratified by severity were defined using the disease activity score in 28 joints (DAS28). We evaluated the impact, in terms of costs (US dollars), for providing RA clinical care for a previously described cohort using the CoE approach. Statistical analyses were performed in Microsoft Excel®, and R. Results Expenditure on therapeutic drugs increases as the severity of RA increases. Drugs represent 53.6% of the total cost for the low disease activity (LDA) stage, 75.2% for moderate disease activity (MDA), 88.5% for severe disease activity (SDA) and 97% for SDA with biologic treatment (SDA+Biologic). Treating 968 patients would cost US$612,639 (US$487,978-1,220,160) at baseline, per year. After a year of follow-up at the CoE, treating the same patients would cost US$388,765 (US$321,710-708,476), which implies potential cost-savings of up to US$223,874 per year. Conclusion The strategy of providing clinical care for RA through CoE can save US$231.3 per patient-per year. The results of our study show that CoE could greatly impact the public policies dealing with treatment of RA in Colombia. Applying the CoE model in our country would both improve health outcomes, as well as being more efficient in terms of costs.
Collapse
Affiliation(s)
| | | | | | | | | | - Nelson Alvis-Guzmán
- Department of Health Sciences, Universidad de la Costa - CUC, Barranquilla, Colombia.,Department of Economic Sciences, Universidad de Cartagena, Cartagena, Colombia
| |
Collapse
|
2
|
Lakomek HJ, Schulz C. [Characteristics of pharmacotherapy in older patients with rheumatism]. Z Rheumatol 2019; 77:369-378. [PMID: 29691687 DOI: 10.1007/s00393-018-0460-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to medical advances and the availability of efficient immunosuppressive therapies, the life-expectancy of people suffering from inflammatory rheumatic diseases is continuously increasing. In Germany, geriatric patients (definition: age older than 70 years combined with geriatric multimorbidity) affected, e. g. by rheumatoid arthritis (RA) frequently receive corticosteroids and less often biologic disease-modifying antirheumatic drugs (bDMARDs) and conventional DMARDs (cDMARDs), which is justified by additionally existing comorbidities and polypharmacy. Using geriatric typical assessments as well as detailed medication regimens the treatment risk of bDMARD and cDMARD administration can be properly evaluated. Current data on biological therapy in older patients with rheumatism support this recommendation. Following the "choosing wisely" initiative of the German Association of Internal Medicine the authors listed 5 positive and 5 negative recommendations concerning the pharmacotherapy of older patients suffering from rheumatism (e. g. RA) as practical guidance towards safer bDMARD and cDMARD treatment for geriatric RA patients.
Collapse
Affiliation(s)
- H-J Lakomek
- Klinik für Rheumatologie und Universitätsklinik für Geriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | | |
Collapse
|
6
|
Armuzzi A, Lionetti P, Blandizzi C, Caporali R, Chimenti S, Cimino L, Gionchetti P, Girolomoni G, Lapadula G, Marchesoni A, Marcellusi A, Mennini FS, Salvarani C, Cimaz R. anti-TNF agents as therapeutic choice in immune-mediated inflammatory diseases: focus on adalimumab. Int J Immunopathol Pharmacol 2014; 27:11-32. [PMID: 24774504 DOI: 10.1177/03946320140270s102] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The complex pathogenesis of immune-mediated inflammatory diseases (IMIDs) has been extensively investigated and dysregulation of cytokines, such as tumour necrosis factor (TNF) has been shown to play a dominant role in the pathogenesis of various IMIDs, such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis and psoriatic arthritis. The subsequent development of biological agents capable of blocking TNF has led to important advances in the pharmacotherapy of such diseases and confirmed the concept of a common pathophysiology among IMIDs with TNF having a predominant role. Five TNF inhibitors have currently been approved for treatment of one or more IMIDs; these include infliximab, etanercept, adalimumab, golimumab and certolizumab pegol. Given the similarities in the pathogenic background of IMIDs, one could expect that anti-TNF agents be similarly effective and with comparable tolerability profiles; however, this may not be the case. Structural and pharmacological differences among the anti-TNF drugs are likely to result in differences in efficacy and tolerability among the agents in the different IMIDs, together with differences in potency, therapeutic dose ranges, dosing regimens, administration routes, and propensity for immunogenicity. Among the five TNF inhibitors approved for treatment of IMIDs, adalimumab has the widest range of indications. Data from controlled clinical trials of adalimumab, showing its excellent efficacy and tolerability in a wide range of indications, are supported by real-world long-term data from observational studies, which confirm the value of adalimumab as a suitable choice in the management of IMIDs.
Collapse
Affiliation(s)
- A Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - P Lionetti
- Gastroenterology Unit, Anna Meyer Childrens Hospital, Department of Paediatrics, University of Firenze, Firenze, Italy
| | - C Blandizzi
- Division of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Caporali
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - L Cimino
- Ocular Immunology Unit, Ophthalmology, Unit, Arcispedale S Maria Nuova Reggio, Reggio, Emilia, Italy
| | - P Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Lapadula
- Rheumatology Unit, Interdisciplinary Department of Medicine, Medical School, University of Bari, Bari, Italy
| | | | - A Marcellusi
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - F S Mennini
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - C Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - R Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Childrens Hospital, University of Florence, Firenze, Italy
| |
Collapse
|