Cost-efficacy of remissive drugs and a control problem of rheumatoid arthritis in patients living in the highlands

Abstract

De un total de 322 pacientes con Artritis Reumatoide (AR) evaluados en este periodo en nuestro hospital, 50 pacientes con diagnóstico definitivo de AR, que radican en altura, fueron incluidos en un estudio prospectivo, longitudinal, comparativo y experimental, para valorar en un seguimiento mínimo de 6 meses, el costo-eficacia de bajas dosis de metotrexato (MTX), versus aureotiomalato de sodio (AUTS). Fueron randomizados: grupo MTX 30 pacientes que recibieron la droga (promedio 7.5 mg/sem V O), grupo A UTS 20 pacientes que recibieron un promedio de 50 mg/sem 1M, luego de dosis iniciales de 10-25 mg/sem. Ambos grupos presentaron una mejora clínica evidente, valorados con los índices de actividad, factores pron6sticos y puntaje de severidad propuestos por Wilke y Clough modificados. En el grupo MT X: score inicial de actividad 7.4 y final de 1.8. En el grupo AUTS score inicial 7.2, final 2.0. El puntaje de severidad para el grupo MTX inicial 11.4 y final 3.8; para A UTS inicial 11.2 y final 4.0. La eficacia de ambas drogas remisivas fue similar a los 6 meses de la evaluaci6n inicial (p>0.05). Sin embargo, se encontró diferencias amplias en el costo unitario $527 pac/año para AUTS versus$ 18 pac/año para M TX, concluyéndose que el MTX es 29 veces más econ6mico que AUT S, conservando ambos la misma eficacia, por lo que se justifica su primera elecci6n como droga remisiva en AR de altura, dentro del desarrollo de un Programa de Control Preventivo Promocional de AR que proponemos.From a total of 322 patients with Rheumatoid Arthritis (RA) who were assessed in this period in our hospital, 50 patients with definite diagnosis of RA who live in the highlands, were included in a prospective, longitudinal, comparative and experimental study, in order to assess in a minimal 6-month follow-up the cost-efficacy of low doses of metotrexate (MTX), versus sodium aureothiomalate (SAUT). The randomized groups were as follows: MTX group, 30 patients who received the drug (average of 7,5 mg/sem VO), SAUT group, 20 patients who patients an average of 50 mg/sem IM, after initial doses of 10-25 mg/sem. Both groups showed a clear clinical improvement, assessed through modified activity rates, prognosis factors and severity score proposed by Wilke and Clough. For the group MTX, the initial activity score was 7,4 and the final one 1,8. For the SAUT group, the initial score was 7,2 and the final one 2,0. The initial severity score for the MTX group was 11,4 and the final one 3,8; for the SAUT group, the initial one was 11,2 and final one 4,0. The efficacy of both remissive drugs was similar trough the 6 months of the initial evaluation (p>0,05). However, considerable differences were found in the unitary cost: $527 pac/year for SAUT versus$ 18 pac/year for MTX, concluding that the MTX is 29 times more economical than the SAUT, both keeping the same effectiveness. This justifies its first election as remissive drug for high-land RA, within the development of a Preventive-Promotional Control Program for RA that is being proposed