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Objective: To perform a cost-minimization analysis comparing the cohort with the current average patient weight of 70 kg (MoH current assumption). Since most rheumatoid arthritis (RA) patients in Brazil are women (60 kg or less), we also aimed to define this percentage at Brazilian public healthcare system (SUS). Methods: Treatment-naïve RA patients using biologics from January 2008 to November 2018 were retrieved from Datasus as well as the number of patients ≤ 60 kg and their drug use distribution. Data on drug costs were assessed from the last payment reported by MoH and then recalculated using the weighted average of 60 kg and a 52-weeks a year to assess cost-minimization. Results: In the studied cohort, 33,646 patients (33.3%) were classified as ≤ 60 kg. Annual cost per patient, considering an average weight of 60 kg, ranged from 2,872,29 USD to 4,223.93 USD. Tocilizumab 80 mg was the only drug demonstrating a reduction in annual cost per patient (-526.79 USD). Conclusion: Cost-minimization analysis based on weight-dependent dosage showed that tocilizumab could reduce MoH costs with RA treatment in 14.28%. By adopting weight-dependent dose of 60 kg, the Brazilian government could save up to 916,651.31 USD per year using tocilizumab versus other biological disease-modifying antirheumatic drugs (DMARDs). In ten years, it represents an accumulative saving of 9,166,513.57 USD. RESUMO Objetivo: Realizar uma análise de custo-minimização comparando a coorte com o peso médio de pacientes de 70 kg (atual premissa do Ministério da Saúde – MS). Como a maioria dos pacientes são mulheres (≤ 60 kg), também se objetivou definir esse percentual no sistema público de saúde brasileiro (SUS). Métodos: Pacientes com artrite reumatoide (AR) virgens de tratamento utilizando biológicos de janeiro/2008 a novembro/2018 foram retirados do Datasus, assim como o número de pacientes com ≤ 60 kg e a distribuição de uso das drogas. Os custos dos medicamentos foram avaliados a partir do último pagamento relatado pelo MS e recalculados utilizando a média de 60 kg e um ano de 52 semanas para estimar a custo-minimização. Resultados: Na coorte estudada, 33.646 pacientes (33,3%) foram classificados com ≤ 60 kg. O custo anual por paciente, considerando o peso médio de 60 kg, variou de 2.872.29 a 4.223,93 USD. Tocilizumabe 80 mg foi o único que demonstrou redução no custo anual por paciente (-526,79 USD). Conclusão: A custo-minimização baseada em dose peso-dependente mostrou que o tocilizumabe poderia reduzir os custos do MS no tratamento de AR em 14,28%. Ao adotar o peso de 60 kg, o governo poderia economizar até 916.651,31 USD ao ano utilizando tocilizumabe vs. outros medicamentos modificadores do curso da doença biológicos (MMCDb). Em 10 anos, isso representa uma economia acumulada de 9.166.513,57 USD. Received on: 07/02/2019. Approved for publication on: 07/31/2019. 1. Roche Brasil – Produtos Roche Químicos e Farmacêuticos, Department of Specialty Care, São Paulo, SP, Brazil. 2. Roche Brasil – Produtos Roche Químicos e Farmacêuticos, Department of Access, São Paulo, SP, Brazil. 3. Roche Brasil – Produtos Roche Químicos e Farmacêuticos, Department of Medical Affairs, São Paulo, SP, Brazil. * These authors contributed equally for this article. Conflict of interests: The study was funded by F. Hoffmann-La Roche Ltd. and the authors are employees of F. Hoffmann-La Roche Ltd., São Paulo, SP, Brazil. Corresponding author: Giovanna Renelo Puopolo. Av. Engenheiro Billings, 1729, Jaguaré, São Paulo, SP, Brazil. CEP: 05321-900. Telephone: +55 (11) 3719-4674. E-mail: giovanna.puopolo@roche.com

jornal brasileiro de economia da saúde

Cost-minimization analysis of biological disease-modifying antirheumatic drugs in the Brazilian public health system (SUS) considering patients’ weight