6070 The increasing cost of biological treatment in paediatric rheumatology

Objectives The advance of biological therapies has revolutionised paediatric rheumatology, greatly improving patient outcomes.¹ However, these novel treatments are expensive compared to conventional therapies (steroids and methotrexate) and their increased usage places further burden on already strained health services. Costs arise partly from pharmaceutical premiums but also in the increased administration requirements such as bedspace time and staffing for infusions within the paediatric clinical investigations unit (CIU). The aim was to investigate the change in long-term biological treatment use within NHS Tayside paediatric rheumatology, both day-patient and community based, and the associated cost implications. Methods Patient records were used to obtain data on medication dosages and number of infusions. Equipment prices were obtained from NHS procurement services. CIU bed space cost was extrapolated from data provided by the finance department. Drug costings were based on BNF pricing. Full costings for hospital and homecare treatments in 2020 and 2021 were compared. Results From 2020 to 2021 the number of CIU infusion sessions for paediatric rheumatology patients increased by 40% (43 vs 60), despite the same number of patients receiving treatment (n = 7). Additionally, the cost per infusion per child increased by 4% reflecting the larger doses required as a child grows. Overall, the cost of providing CIU- based day-patient biologic treatment increased by 40% (£124,000 vs £172,000) in a two-year period. The number of patients receiving community biologic treatment increased by 40% (15 vs 21), with a resultant 53% total cost increase (£51,000 vs £77,000) from 2020 to 2021. Annually, managing a patient with a biological therapy delivered in a day-patient setting costs nearly 7x as much as community biologic treatment (£21,000 vs £3000). Figure 1 compares the cost and number of patients treated in both day-patient and community settings. Conclusion In a two-year period, the NHS Tayside paediatric rheumatology department has observed a substantial increase in biological therapies use, both in community and day- patient settings, with a subsequent steep rise in costs. The increased usage is due to two reasons: more intensive therapeutic regimens (day-patient) and new patients starting on biologics (community treatment). As community biologic treatment is significantly cheaper than day-patient care this should be actively pushed for when there is non-superiority amongst treatment options. The increasing costs for the delivery of immunologic therapy need to be factored into future budget planning to ensure that children can continue to receive the recommended standard of care. Reference Sen ES, Ramanan AV. New age of biological therapies in paediatric rheumatology. Archives of Disease in Childhood 2014.