Optimization of drug provision for patients with rheumatoid arthritis based on a pharmacoeconomic analysis in the Republic of Kazakhstan

BACKGROUND: Providing the least costly, safe, and highly effective pharmacotherapy to patients with rheumatoid arthritis remains an urgent issue.

AIM: This work aimed to develop approaches for optimizing drug provision for patients with rheumatoid arthritis (using the city of Almaty as an example).

METHODS: This work used the information resources of the Ministry of Health of the Republic of Kazakhstan; reports from the Almaty City Rheumatology Center, the State Register of Medicinal Products of the Republic of Kazakhstan, the Clinical Protocol for the Diagnosis and Treatment of Rheumatoid Arthritis No. 12 dated September 29, 2016; wholesale prices for medicinal products, antineoplastic agents, and immunomodulators (anatomical therapeutic chemical groups L01, L04) provided by the City Rheumatology Center; and statistical indicators accumulated based on data from the World Health Organization and the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan.

RESULTS: The highest disease prevalence (60%) was observed among working-age patients aged 35–55 years, whereas only 0.36% of the medicinal products used belonged to biologic agents. The cost ranking (ascending order) of adverse drug reaction therapy was as follows: adalimumab, etanercept, rituximab, tocilizumab, golimumab, and infliximab. With regard to additional cost expenditures, the leading agents (based on the lowest cost of the treatment course) were golimumab, rituximab, and infliximab. The lowest total treatment cost across all treatment stages (in ascending order) was identified for etanercept, adalimumab, and infliximab.

CONCLUSION: Strengthening physician-led patient education regarding treatment strategies is necessary to improve adherence among patients with rheumatoid arthritis. To expand therapy options, the inclusion of etanercept in the guaranteed free medical care list must be considered. To reduce expenditures for medicinal provision, producing biologic agents in the Republic of Kazakhstan is required.