| dc.description.abstract | Background: Rheumatoid arthritis (RA) places a considerable economic burden on society, and biologic Disease Modifying Anti-Rheumatic Drugs (bDMARDs) for the treatment of RA are associated with high costs. The Norwegian Drug Procurement Cooperation (LIS) aims to reduce the costs by recommending choice of bDMARDs based on tender prices. Here, all bDMARDs are assumed to have equal effectiveness and the biologic with lowest drug cost is recommended. Objective: The overarching objective of our study was to explore the societal costs among nine different biologics included in the 2015 LIS recommendations (TNF/BIO) for the treatment of RA and compare LIS recommendations with ranking of the drugs according to societal costs. Methods: To calculate the costs of biologics, from a societal perspective, we collected one yearone-year data on drug dose, frequency and price (based on both LIS rules and empirical data from Diakonhjemmet Hospital), drug administration costs, and non-medical costs (patient co-payments, travel cost, loss of production and leisure). We used micro-costing for the drug administration costs and Google Maps for estimating travel time and distance. We performed a cost minimization analysis based on the assumption that biologics have equal effectiveness. Nine different biologics with in total 14 administration forms were included: five intravenous infusions (Remsima, Inflectra, Remicade, RoActemra, Orencia) and nine subcutaneous injections (Cimzia, Simponi syringe, Simponi pen, Orencia, Orencia with bolus, RoActemra, Enbrel syringe, Enbrel pen, Humira). Using 2015 data, we based the primary analysis on data from the rheumatology outpatient clinic at Diakonhjemmet Hospital. A cost model was developed in Microsoft Office Excel. Uncertainty was expressed as confidence intervals and estimated by means of Monte Carlo simulations. Scenario analyses for rheumatology departments elsewhere in the country was performed to investigate generalizability of the findings. A literature review on the comparative effectiveness of the biologics were undertaken. Results: For Diakonhjemmet Hospital, Remsima had the lowest drug cost (NOK25 944; 95% CI 25 466-26 421) and societal cost (NOK59 867; 95% CI 59 367-60 368) based on LIS rules. For 10 drugs, there were some disagreement between the 2015 LIS recommendations and the ranking of societal costs according to our analyses. The cost ranking of the 14 drugs varies somewhat across rheumatology departments depending on variation in travel distances, and loss of production and leisure. Conclusion: Although LIS first line recommendation of biologic for RA was in line with the societal costs for Diakonhjemmet Hospital and five other rheumatology departments in Norway, the LIS recommendations do not necessarily minimize societal costs. The results of our study indicate that health authorities would do well by basing treatment guidelines on thorough cost analyses. | eng |