Ab1349 Biologic and Targeted Synthetic Drugs Management in Rheumatoid Arthritis After Implementation of a Community Optimization Protocol

Background: Due to the wide therapeutic arsenal currently available for the treatment of rheumatoid arthritis (RA), it is necessary to assess its economic impact on the national health system (NHS) and to establish optimization strategies for its appropriate use. In Cantabria, Rheumatology and Hospital Pharmacy departments have drawn up a corporate protocol for the optimization of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs). Objectives: To evaluate the application of optimization protocol of biologic and targeted synthetic DMARDs in RA patients, as well as its impact on health care costs. Methods: Multicenter and retrospective analysis, carried out in the three public hospitals of the Cantabria region (Spain). All RA patients treated with biologic or targeted synthetic DMARDs were included. The baseline situation was evaluated (Jun-21) and protocol application was monitored at 6 (Dec-21) and 15 months (Sep-22). Patient data were extracted from the assisted electronic prescription program and included: drug, posology and reasons for posological changes. In addition, for each drug, the standard dosing regimen according to the technical data sheet and the unit cost were used as comparators. In the periodic measurements, the number of optimized and intensified patients was established for each drug, in order to calculate the percentage of optimization and intensification of each drug with respect to the dosing regimen indicated in the technical data sheet. From the unit cost of the drug, the expected annual cost and the real annual cost were also calculated, taking into account the real dosing regimen for each patient. Results: Data were included for the 17 drugs used in RA with a total of 815 patients on treatment in September 2022 (12% annual increase in the number of patients). After protocol implementation, the percentage of optimized patients increased from 17.1% (baseline) to 26.1% (month 6) and 26.6% (month 15). The percentage of intensified patients remained at 0.6% during this period. In terms of costs, expected annual savings of 537644.5 euros (baseline), 690689.2 euros (month 6) and 726040.9 euros (month 15) were obtained, which in relative terms means an annual saving of 8.3% (baseline), 11.9% (month 6) and 14.2% (month 15). In other words, in 15 months we have managed to increase the expected annual savings by 35% with respect to the baseline situation. Drugs with the highest optimization percentage were tocilizumab, etanercept (Enbrel), adalimumab (Humira) and golimumab (Table 1). Conclusion: After protocol implementation, the optimization rate achieved is consistent with the indications of the clinical guidelines. One out of four patients decreased the dose or increased the drug administration interval. Consequently, a considerable reduction in costs was observed. The drugs with the highest percentage of optimization are those with the greatest experience of use. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.