Are the new biologic drugs for rheumatoid arthritis worth the cost?

Are the new biologic drugs for rheumatoid arthritis worth the cost?

The standard initial therapy for rheumatoid arthritis (RA) consists of methotrexate as a disease-modifying anti-rheumatic drug (DMARD) and either a nonsteroidal anti-inflammatory drug (NSAID) or low-dose prednisone. Although these medications work to some extent, they rarely result in remission.

TNF inhibitors such as Enbrel, Humira, and Remicade have revolutionized our approach to RA and allowed rheumatologists to put patients into remission.

The high cost of biologic agents has brought “pharmacoeconomic” considerations as a factor to be addressed in the treatment of patients with rheumatoid arthritis. There is a growing body of data confirming the significant cost implications of various arthritic conditions. For TNF inhibitors, clinical effectiveness must be taken into account when assessing their value.

In RA, there is a growing body of data addressing the potential cost-effectiveness of TNF inhibitors. As a result of their remarkable clinical efficacy, it appears that TNF inhibitors may have incremental cost-effectiveness in RA.

Much of the data on which this is based comes from the follow-up of patients who have participated in clinical trials with these agents over the past decade. In general, changes in health status using specific quantifiable performance measures for activities of daily living have demonstrated cost-effectiveness.

The use of anti-TNF drugs and subsequent measurement of their effect on functional ability has created the opportunity to define response to treatment in terms of quality-adjusted life years (QALYs) gained.

A number of studies have shown improvements in work status with treatment.

Other studies have begun to examine the effect of TNF inhibitor treatment on employability; In one study, such treatment significantly improved employability and reduced days lost from work.

In addition, ongoing studies are developing models that compare the outcomes of patients capable of productive work with what would happen in the event of progressive disease and crippling. A patient who does not have access to an anti-TNF drug and becomes crippled cannot be a positive producer for the economy. Additionally, there would be a negative impact on the economy in the form of dollars needed for medical care for this patient.

Unfortunately, insurance companies that make access to these medicines more difficult are taking a very short-sighted view of things. Hopefully, further studies documenting the value to society and individuals of remaining productive and having a better quality of life will change this situation for the better.

Inspired by Nathan Wei