ABSTRACT
Background: The rheumatologists have several drugs to choose from, either alone or in combination; each with different costs, monitoring protocols, and potential risks and benefits. Pharmacoeconomic analysis results help rheumatologists choose drugs for their patients. Objective: Objective of this prospective observational study was to perform a cost-variation analysis of drugs prescribed for the treatment of rheumatoid arthritis (RA) in a Western-Indian tertiary care teaching hospital. Materials and Methods: This prospective observational study was conducted in the rheumatology department of the study site. Study population included patients of both gender male and female, diagnosed with rheumatoid arthritis and on treatment. Prices of the drugs prescribed to the patients were obtained from different offline and online sources. The lowest and highest cost of brands in rupees (INR) for each drug, the cost ratio, percentage cost variation, and monthly cost for all the prescribed drugs were calculated. Results: In our study, out of total 142 patients, 93 were females and 49 were males and the mean age was 49.11±15.89 years. Most patients were prescribed with Disease-modifying antirheumatic drugs (DMARDs). Frequently used nonsteroidal anti-inflammatory drug (NSAID) was Diclofenac (n=48). A maximum cost ratio (15.6) was observed with prednisolone 5 mg TDS. The costliest and cheapest brand of prednisolone 5 mg TDS accounted for the maximum cost variability (1460%). Mean monthly cost varied among different drug classes. Conclusion: Average cost of illness of patient with RA was estimated to be in the range of 2406/month to 2858/month in the year 2021.
ABSTRACT
Refractory or relapsed Multiple Myeloma (MM) is a plasma cell neoplasia characterized by paraproteins in the urine or serum and a bone marrow plasmacytosis of over 10%. Multiple/refractory myeloma is a neoplasm of plasma cells and exact cause of multiple myeloma is remain unidentified, it is characterized by accumulation of malignant plasma cells in the bone marrow, leading to bone marrow failure, anemia, skeletal destruction, renal failure, increased susceptibility to infection and hypercalcemia. The survival time for the patients with refractory or multiple myeloma can be prolonged with treatment of newer and more target specific approach. The proteasome inhibitors are an important class of anti-myeloma drugs that have efficacy to disrupt the proteolytic structure of tumor cells and enhancing their susceptibility to apoptosis. Bortezomib has a significant clinical efficacy against refractory multiple myeloma. Bortezomib is the most commonly used and clinically tested proteasome inhibitor and which is effective in prolonging the overall survival in several trials. Bortezomib combinations with other drugs such as dexamethasone and cyclophosphamide are the choice of treatment for standard risk patients following the mSMART guidelines. The success with lower dosage of bortezomib in elderly patient’s proven efficacious subcutaneous usage and its useful proteasome inhibitor to enhance patient’s compliance and reduces toxicity and costs of therapy. This review discusses on special emphasis of bortezomib on relapsed/refractory multiple myeloma as front-line treatment.