https://orcid.org/0000-0001-7802-0317
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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.
Statements of Ethical Approval
This study was approved by the Institutional Research Board of Biomab IPS, act 004-25042017. All patients had previously signed informed consent for data use. This study did not represent risks for the patients according to the Resolution 8430 of 1993 of the Ministry of Health of Colombia. All data that could identify a patient were anonymized.
Acknowledgments
We would like to thank Mark Javier Makepeace for editing and reviewing this manuscript for English language.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
Pedro Santos-Moreno reports previous grants from AbbVie, personal fees and non-financial support from Biopas-UCB, Janssen, Pfizer, Bristol, Roche, and personal fees from Lilly. The other authors reported no potential conflicts of interest for this work.