Optimizing Treatment for Rheumatoid Arthritis in The Kingdom of Saudi Arabia (OPTRA)

OBJECTIVES: To estimate the direct medical and non-medical costs of managing severe rheumatoid arthritis (RA) in the Kingdom of Saudi Arabia(KSA) and to assess the budget impact of introducing the new oral advanced treatments (OATs) in KSA from a payer's perspective.METHODSA budget impact model was developed to assess the costs of current practice in the KSA Ministry of Health hospitals for treatingsevere RA patients, compared with three alternative scenarios. Scenario 1 (S1) assumed switching 100% of current severe RApatients to OATs over 1 year. Scenario 2 (S2) assumed switching 30% of current severe RA patients and 50% of those newlydiagnosedto OATs, while scenario 3 (S3) assumed switching 30% and 100%, respectively to OATs, both over three years. Allscenarios assumed that OATs had equivalent safety and efficacy to biologics. The cost categories considered included drugacquisition, preparation and administration, medication transportation and cold chain storage among others. All assumptions madewere based on literature review and key opinion leaders’ interviews. RESULTS: The current practice total cost was estimated to be over SAR 361 million /year ($1=3.75 SAR). Drug acquisition, monitoring, traveland accommodation costs for the parenterally-administered biologics were the main drivers of cost. S1, S2 and S3 showed costsavings of 35%, 10.6% and 10.8%, respectively. The average cost /patient/year decreased from SAR 64,000 in the base case to SAR45,000 in S1 and to SAR 55,000 in S2 and S3.CONCLUSIONS: Switching severe RA patients to OAT would significantly reduce the cost of severe RA management in KSA. The use of OAT willsignificantly reduce the costs associated with parenteral and subcutaneous RA drug administration (travel, accommodation, hospitalvisits for drug infusion and outpatient visits) for both the patients and the health systems, freeing-up healthcare resources for othermedical needs