Economical Evaluation of the Sustain Program for the Out-of-Hospital Administration of Abatacept for Rheumatoid Arthritis

Valutazione economica del programma SuSTAin per la somministrazione territoriale di abatacept nel trattamento dell'artrite reumatoide

Abstract

Background The introduction of biological therapies has greatly improved treatment of rheumatoid arthritis (RA) and patients' quality of life. Abatacept is a biological drug that can be given every 28 days by Intravenous Infusion (IvI). IvI administration takes a short period of time and does not require pre-medications nor specific post-infusion support. These characteristics allowed the launch of the SuSTAin Program for the out-of-hospital administration of abatacept IvI. Object The main aim of this analysis was to assess the economic value generated by the SuSTAin Program for rheumatology centres and the Italian National Health Service (INHS). Methods Using the SuSTAin database and supported by a Delphi panel of eleven Italian rheumatology experts – one from each participating centre – we collected data about infusion duration and costs of IvI administration (nurse and rheumatologist)/control visit (rheumatologist). The analysis evaluated the saving generated by the SuSTAin Program for the INHS (avoided refunds by INHS to rheumatology centres) and patient's adherence to IvI administrations in the SuSTAin Program. Costs were assessed in Euros 2015. Results From December 2010 to August 2015, eleven Italian rheumatology centres adopted the SuSTAin Program and 2,856 infusions were given to 135 patients. In each centre, an infusion was shown to take approximately 123.7 minutes and a control visit 30 minutes. Based on the average hourly wage of a rheumatologist and a nurse and the time they dedicate to the infusion, the mean cost per infusion was €66.71. The potential saving for rheumatology centres amounted to €194,134, while the real saving for INHS was €32,234. Data showed a high level of patients' adherence (97%). Conclusions The SuSTAin Program represents an innovative way to support patients with RA when treated with abatacept IvI, generating measurable economic value for both rheumatology centres and INHS.