Table 1.
Key costs for the management of RA in Zanzibar.
| Item | Zanzibar | Range | |
|---|---|---|---|
| Unit costs, 6-months (USD) | Low | High | |
| Methotrexate (+folic acid)1 | 45 | 22.5 | 67.5 |
| Bridging therapy2 | 6 | 3 | 9 |
| Sulfasalazine1 | 127 | 63.5 | 190.5 |
| Hydroxychloroquine1 | 111 | 55.5 | 166.5 |
| 1st b/tsDMARD3 | 94* | 47 | 141 |
| 2nd b/tsDMARD3 | 5456* | 2,728 | 8,184 |
| Prednisolone4 | 20 | 10 | 30 |
| Costs at diagnosis5 | 125 | 62.5 | 187.5 |
| Investigations to continue csDMARDs (1st cycle) | 57 | 27.5 | 82.5 |
| Investigations when starting b/tsDMARDs | 157 | 77.5 | 232.5 |
| Costs to continue csDMARD therapy6 | 25 | 20.5 | 61.5 |
| Costs to continue b/tsDMARDs7 | 56 | 3.5 | 10.5 |
| Clinic visit costs (per visit)8 | 4 | 2 | 6 |
USD, United States dollar; csDMARDs, conventional synthetic disease modifying anti-rheumatic drugs; b/tsDMARD, biologic/targeted-synthetic disease modifying anti-rheumatic drugs. All costs are aggregated for 6 months except for clinic visit costs.
Costs for hydroxychloroquine 400 mg/day, sulfasalazine 2000 mg/day, and methotrexate 25 mg/week (+folic acid 5 mg once weekly).
Costs of prednisolone at 15 mg tapered over 6 weeks, calcium + vitamin D supplement and omeprazole.
Approximate prices for conventional dosage of the two cheapest b/tsDMARD in 2022 administered at recommended adult doses for rheumatoid arthritis therapy.
Prednisolone as rescue therapy at 5 mg/day. Used with Calcium + Vitamin D which contribute USD 18 to the total.
Costs of investigations required to diagnose, start therapy, and contraception.
Costs of investigations once/cycle for patients at target and twice/cycle for patients not at target.
Costs of pneumococcus vaccine, prophylaxis with cotrimoxazole, isoniazid preventive therapy and contraception as well as screening for pulmonary tuberculosis with chest radiograph.
Costs of staff, building, supplies and utilities per patient per clinic visit.