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Vol. 17. Issue 6.
Pages 335-342 (June - July 2021)
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Vol. 17. Issue 6.
Pages 335-342 (June - July 2021)
Original Article
DOI: 10.1016/j.reumae.2019.10.007
Cost evolution of biological drugs in rheumatoid arthritis patients in a tertiary hospital: Influential factors on price
Evolución del coste de medicamentos biológicos en pacientes con artritis reumatoide en un hospital terciario. Factores influyentes en dicha evolución
Mariángeles González Fernándeza,
Corresponding author
, Elena Villamañánb, Inmaculada Jiménez-Nácherb, Francisco Morenob, Chamaida Plasenciac, Francisco Gayád, Alicia Herrerob, Alejandro Balsac
a Pharmacy Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
b Pharmacy Department, La Paz University Hospital, Madrid, Spain
c Rheumatology Department, La Paz University Hospital, Madrid, Spain
d Biostatistic Department, La Paz University Hospital, Madrid, Spain
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Figures (2)
Tables (7)
Table 1. Characteristics of patients.
Table 2. Economic data evolution per drug from 2009 to 2017 in rheumatoid arthritis.
Table 3. Official discounts and negotiated rebates from 2009 to 2017.
Table 4a. Clinical characteristics of patients according to the optimizations of their treatments.
Table 4b. Number of active patients and % patients with optimized therapies per drug.
Table 5. Calculation of different factors that have an impact on costs in 2017.
Table 6. Quantification of influential factor that affect on treatment costs in rheumatoid arthritis.
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To assess the evolution of cost per patient/year and the cost per patient/year/drug in patients with rheumatoid arthritis (RA) receiving biological treatments. To analyze and quantify the factors influencing this evolution, such as the optimization of the biological drugs, the use of biosimilars, and official discounts and discounts obtained after negotiated procedures. In addition, to assess specific clinical parameters of disease activity in these patients.


Retrospective, observational study conducted in a Spanish tertiary hospital. Adult patients diagnosed with RA under treatment from 2009 to 2017 were included.


320, 270 and 389 patients were included in 2009, 2013 and 2017, respectively. The patient/year cost decreased from 10,789€ in 2009, 7491€ in 2013 to 7116€ in 2017. In 2017, due to the established competition, discounts of 14% and 29.5% were achieved on etanercept and its biosimilar; 11.5%, 17.8%, 17.9%, 17.3% on adalimumab, certolizumab, golimumab and tocilizumab IV respectively, and 24.6% and 43.1% on infliximab and its biosimilar. The percentage of patients optimized in 2017 was 35.2%. The annual saving in 2017 was 1,288,535€ (830,000€ due to dose optimization and/or administration regimens, 249,666€ corresponding to 7.5% of the official discount and 208,868€ after negotiated procedures).


The annual cost per patient in RA decreased considerably due to different factors, such as discounts on the purchase of drugs due to official discounts and negotiated procedures, together with the optimization of therapies, the latter being the factor that contributed most to this decrease.


Evaluar la evolución del coste por paciente/año y del coste por paciente/año/medicamento en pacientes en tratamientos con biológicos con artritis reumatoide (AR). Analizar y cuantificar los factores influyentes en dicha evolución tales como la optimización de medicamentos biológicos, el uso de biosimilares y los descuentos oficiales y los obtenidos tras procedimientos negociados. Además, evaluar parámetros clínicos de la actividad propios de la enfermedad en dichos pacientes.


Estudio retrospectivo, observacional, realizado en un hospital terciario español. Se incluyeron pacientes adultos diagnosticados de AR en tratamiento con biológicos desde 2009 a 2017.


Se incluyeron 320, 270 y 389 pacientes en 2009, 2013 y 2017, respectivamente. El coste paciente/año disminuyó de 10.798€ en 2009, 7.491€ en 2013 a 7.116€ en 2017. En 2017, debido a la competencia establecida, se alcanzaron descuentos del 14 y del 29,5% en etanercept y su biosimilar; 11,5, 17,8, 17,9 y 17,3% en adalimumab, certolizumab, golimumab y tocilizumab IV, respectivamente, así como un 24,6% y 43,1% en infliximab y su biosimilar. El porcentaje de pacientes optimizados en 2017 alcanzó el 35.2%. El ahorro anual en 2017 fue de 1.288.535€ (830.000€ debido a la optimización de dosis y/o pautas de administración, 249.666€ correspondiente al 7,5% del descuento oficial y 208.868€ tras procedimientos negociados).


El coste anual por paciente en AR disminuyó considerablemente debido a diferentes factores, tales como, descuentos en la adquisición de medicamentos debido a descuentos oficiales y procedimientos negociados, junto a la optimización de terapias, siendo este último el factor que más contribuyó en dicho descenso.

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