Antirheumatic Medicine Prescribing Patterns and Direct Medicine Costs in the South African Private Health Sector.

OBJECTIVES: To describe antirheumatic medicine prescribing patterns and to estimate the total annual direct medicine cost of rheumatoid arthritis (RA) in the private health sector of South Africa. METHODS: A retrospective, cross-sectional drug utilization study was performed on medicine claims data from January 1, 2014, to December 31, 2014, for a total of 4,352 patients with RA. Patients were divided into those with RA only and those with RA and other chronic disease list conditions. Antirheumatic treatment was categorized into bridge therapy (nonsteroidal anti-inflammatory drugs [NSAIDs] and corticosteroids only) and therapy for advanced disease (NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs [DMARDs] or biologics). Cost-driving products, the 90% drug utilization (DU90%) segment, mean, and median medicine item costs were calculated. RESULTS: Annual direct RA medicine cost summed to €4,115,569.70. The mean ± SD (median) cost per medicine item was €45.87 ± €250.35 (€9.01). DMARDs represented 47.6% (n = 42,699) and biologics 2.4% (n = 2,150) of the 89,728 medicine items claimed. The DU90% of bridge therapy products accounted for 92.8% of the total medicine cost, with celecoxib as the main cost driver because of high volume and mean cost. The therapy for advanced disease DU90% segment accounted for 34.7% of the total medicine cost, with adalimumab as the main cost driver because of high mean cost. CONCLUSIONS: The direct medicine treatment cost of RA in the South African private health sector is driven by the high volume of DMARDs and the high mean costs of biologics, particularly adalimumab.

Chronic disease list conditions in patients with rheumatoid arthritis in the private healthcare sector of South Africa.

INTRODUCTION: Little is known about the burden of rheumatoid arthritis (RA) in South Africa. The aim of this study was to establish the prevalence of RA and coexisting chronic disease list (CDL) conditions in the private health sector of South Africa. METHODS: A retrospective, cross-sectional analysis was performed on medicine claims data from 1 January 2014 to 31 December 2014 to establish the prevalence of RA. The cohort of RA patients was then divided into those with and those without CDL conditions, to determine the number and type of CDL conditions per patient, stratified by age group and gender. RESULTS: A total 4352 (0.5%) patients had RA, of whom 69.3% (3016) presented with CDL conditions. Patients had a median age of 61.31 years (3.38; 98.51), and 74.8% were female. Patients with CDL conditions were older than those patients without (p < 0.001; Cohen's d = 0.674). Gender had no influence on the presence of CDL conditions (p = 0.456). Men had relatively higher odds for hyperlipidemia (OR 1.83; CI 1.33-2.51; p < 0.001) and lower odds for asthma (OR 0.83; CI 0.48-1.42; p = 0.490) than women. In combination with hyperlipidemia, the odds for asthma were reversed and strongly increased (OR 6.74; CI 2.07-21.93; p = 0.002). The odds for men having concomitant hyperlipidemia, hypertension, type 2 diabetes mellitus and hypothyroidism were insignificant and low (OR 0.40; CI 0.16-1.02; p = 0.055); however, in the absence of hypothyroidism, the odds increased to 3.26 (CI 2.25-4.71; p < 0.001). CONCLUSION: Hypothyroidism was an important discriminating factor for comorbidity in men with RA. This study may contribute to the body of evidence about the burden of RA and coexisting chronic conditions in South Africa.