Publication

Abstract : Rheumatoid arthritis (RA), being destructive to the joints, imposes considerable disease burden and is associated with major socioeconomic implications to the affected population. The treatment cost varies depending on the medicines used, like, a comparatively cheaper Disease Modifying Anti Rheumatic Drug (DMARD) or a costlier biological agent. The main objective of the study was cost effectiveness analysis of various DMARDs used in the management of RA. The design of the study was a prospective, longitudinal and observational study for a period of ten months in a tertiary care referral hospital in Kerala, India. All RA patients attended the Rheumatology OPD with 3 months' follow-up and who met the inclusion criteria was included in the study. Cost effectiveness analysis was done by taking HAQ DI score as a measure of effectiveness. Out of the 266 patients, 16.48 % were males and 83.52 % were females. RA Factor is positive for 91.01 % of patients and negative for 8.99 % of patients. Most patients (69.66 %) were on one DMARD, and a few (30.34 %) were on two DMARDs. The mean value of DAS 28 at baseline visit was 3.36 ± 1.24 and the mean after 3 months' treatment was 2.89 ± 1.09. The mean Disability Indices at baseline and after 90 days were 0.6895 ± 0.488 and 0.3934 ± 0.317 respectively. The Disability Index was highly significant after 90 days than at the baseline (p lt; 0.001). The direct medical cost of treatment of RA per month is Rs.696.57 ($ 15.92). The most cost effective combination of DMARDs was found to be MTX + HQ. The present study supports that the treatment with DMARDs and low dose corticosteroids can control patient's disease activity with reasonable cost of treatment and at minimum risk for side effects.