Cost and effectivennes of a screening algorithm for the diagnosis of rheumatoid arthirits
Costo y eficacia de un algoritmo de detección para el diagnóstico de la artritis reumatoide
Alvis Guzman, N
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AbstractObjectives Rheumatoid arthritis (RA) is a chronic, progressive autoimmune systemic disease affecting roughly 0.7% of the global population. According to direct medical costs, RA has an important economic burden worldwide. We aimed to describe the proportion of patients with a correct or wrong diagnosis of RA when an algorithm of disease diagnosis was applied. Also, we estimated the costs-savings associated with the correct diagnosis of the disease. Methods We performed a descriptive analysis of patients who were referred from primary care centers to a RA specialized one with presumptive diagnosis of RA. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete musculoskeletal examination; it was assessed rheumatoid factor, anti-citrullinated antibodies and other laboratories depending on each case. Also, x-rays of hands/feet were made, and in cases of persistent doubt about the diagnosis, MRI of hands/feet, and/or ultrasound of hands/feet were requested. Descriptive epidemiology was done. We assessed the overall drug expenses related to correct diagnosis of RA. Costs were presented in US dollars at the official rate of exchange for December 2017. Results 1415 patients were evaluated during a 12-month period. After applying the diagnosis algorithm 45% of patients had confirmed RA, while 55% had other diagnosis mainly osteoarthritis. When we calculated the cost-savings related to the adequate diagnosis of RA we saved USD1.300 per patient/year regarding to the following cost items: drugs, medical services and diagnostic control tests. For all diagnosed patients (765) we saved USD$994.500 in twelve months. Conclusions Implementing a clear route to diagnose patients with presumptive RA reduces diagnostic errors, and at the same time it saves a large amount of money for the Colombian health system. Policy-makers should focus on implementing management routes for the adequate patient classification from primary care centers.