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espanolObjetivo: Analisis del coste de las alternativas terapeuticas recogidas en el protocolo de la Comision Autonomica Central de Farmacia y Terapeutica para el tratamiento de la Artritis Reumatoide. Material y metodos: Estudio observacional descriptivo transversal (Abril 2012) de los pacientes a tratamiento con los siguientes medicamentos biologicos: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab y golimumab. Se registro medicamento actual y pauta, tratamiento previo con metotrexato y coste anual del tratamiento. Se elabora una comparativa con la hipotesis de cambio de tratamiento, en el caso de los pacientes con medicamentos de administracion intrahospitalaria, a los medicamentos de dispensacion a pacientes externos incluidos en el protocolo. Resultados: 558 pacientes: 229 a tratamiento con infliximab: 30 (13,1%) con dosis de 3 mg/kg, 173 (75,5%) con 5 mg/kg y 26 (11,4%) con 7 mg/ kg; 27 con abatacept: 5 (18,5%) con dosis de 500 mg, 19 (70,4%) con 750 mg y 3 (11,1%) con 1000 mg; 12 con tocilizumab: 100% con 8 mg/kg; 66 con rituximab 1000 mg; 14 con golimumab 50 mg; 5 con certolizumab 200 mg; 116 con etanercept 50 mg y 101 con adalimumab 40 mg. Un 95,78% (546) habian recibido metotrexato previamente. El coste medio anual se calculo por paciente considerando peso superior a 70 kg y compartiendo viales en el caso de los medicamentos que se preparan en cabina de flujo laminar: infliximab 14.665, abatacept 14.695, tocilizumab 14.140, rituximab 2400/dosis, etanercept 11.879, adalimumab 12.895, certolizumab 11.888 y golimumab 10.316/ano. Siguiendo la hipotesis de cambio de tratamientos administrados en Hospital de Dia a tratamientos de dispensacion ambulatoria los ahorros estimados estarian comprendidos entre 1.245 y 4.379 /paciente. Conclusiones: A la espera de algun estudio que demuestre superioridad de alguno de estos medicamentos frente a otro en eficacia y seguridad, deberia hacerse una adecuada seleccion del medicamento que permita ahorrar recursos tanto en gasto farmaceutico como de personal. Es importante considerar determinados factores como la frecuencia de administracion, posibilidad de alargamiento del intervalo de administracion, determinaciones de anticuerpos frente a los farmacos y valoraciones diagnosticas para mejorar la eficacia/eficiencia de los tratamientos, para asi evitar un posible agotamiento terapeutico. EnglishObjective: Cost analysis of alternative biological therapies included in the Galician Central Autonomous Committee of Pharmacy and Therapeutics protocol for Rheumatoid Arthritis treatment. Material and methods: Descriptive study (April 2012) of rheumatoid arthritis patients being treated with biologics: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab and golimumab. Current medication regimen and annual treatment costs were determined. Cost savings are described assuming changes in treatment, from hospital- administered drugs to the ambulatory administration of medications as outpatients using the protocol recommended biologicals. Results: Of a total of 558 patients, 229 were treated with infliximab: 30 (13.1%) at a dose of 3 mg/kg, 173 (75.5%) with 5 mg/kg and 26 (11.4%) with 7 mg/kg; 27 with abatacept : 5 (18.5%) with doses of 500 mg, 19 (70.4%) with 750 mg and 3 (11.1%) at 1000 mg; 12 tocilizumab: 100% 8 mg/kg; 66 with rituximab 1000 mg, 14 with golimumab 50 mg, certolizumab 200 mg 5; 116 with etanercept 50 mg and 101 with adalimumab 40 mg. 95.78% (546) had previously received methotrexate. The average annual cost was calculated considering patients weighed more than 70 kg and shared vials in the case of drugs that are prepared under aseptic conditions:  14,665 infliximab, abatacept  14,695,  14,140 tocilizumab, rituximab  2,400 / dose,  11,879 etanercept, adalimumab 12,895 , certolizumab and golimumab  11,888  10,316 / year. Following the hypothesis of change in treatments from day hospital to outpatient adminitration, estimated cost savings would amount to between 1245 and  4,379 / per patient. Conclusions: As there is no study showing superiority of any of these drugs against the others in efficacy and safety, there should be a proper medicine selection that would ensure saving both material and personnel resources. It is important to consider certain factors such as administration frequency, possibility of lengthening the dosing interval, determinations of antibodies to drugs and diagnostic evaluations to improve the effectiveness / efficiency rate of treatments,in order to avoid a possible therapeutic exhaustion .

Terapias Biológicas en Artritis Reumatoide: Análisis coste-efectividad de las alternativas terapéuticas