Evaluating the Budget Impact of Introducing Preventive Therapy in the Preclinical Phase for Rheumatoid Arthritis : A Focus on Algerian Female Population at Risk

OBJECTIVES: The early diagnosis and treatment of Rheumatoid Arthritis (RA) are imperative for optimal disease control, greater chances of remission, and prevention of permanent clinical and radiographic damage. This study aims to assess the budget impact of introducing preventive treatment in the preclinical phase for RA among the Algerian population, specifically targeting females at risk. The research compares the budget impact (BI) of this preventive strategy with the current curative approach, incorporating the potential introduction of targeted synthetic DMARDs (tsDMARDs).

METHODS: A systematic literature review provided epidemiological and clinical data. Two budget impact models were developed over a 5-year time horizon, examining the current curative strategy and the preventive strategy, this one involves early identification and treatment in the preclinical phase. Indirect costs were not considered in both models.

RESULTS: Over 5-years, 43.259 RA patients were diagnosed, 53.7% and 32.3% having moderate and severe forms. The overall BI of using conventional and biologic DMARDs is $128.093.332, primarily from medication acquisition. Introducing tsDMARDs may increase the total BI by 0.72%($128.812.940). The preventive strategy's total BI is $789.529.329, mainly due to implementing an early identification strategy for the 40-60 age group female population (n=28.481.000), accounting for 99.9% of the total budget impact. With a test sensitivity not exceeding 50%, 712 new patients are eligible for early Methotrexate (MTX) treatment, costing $57.104, potentially rising to $2.880.220 after introducing Rituximab as a preventive treatment.

CONCLUSIONS: Considering the Algerian healthcare-system, introducing preventive strategies (MTX or Rituximab after early identification) results in a 516% higher budget impact than the current curative approach, even with the introduction of tsDMARDs. Reducing costs requires testing expenses to be below $4.5. Prioritizing curative therapy is crucial until more sensitive tests for early identification are discovered to reduce the economic burden of RA.