Are the New Biologics for Rheumatoid Arthritis Worth the Cost?

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

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

The high cost of biologics has led to “pharmacoeconomic” considerations playing a role in the care of patients with rheumatoid arthritis. There is an increasing body of data confirming the substantial cost implications of various arthritic conditions. For the TNF inhibitors, clinical effectiveness should be considered in an assessment of their value.

In RA, there is a growing body of data on the potential cost-effectiveness of TNF inhibitors. Due to their remarkable clinical efficacy, it appears that TNF inhibitors may have increasing 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 of these agents over the past ten years. Overall, changes in health states, using specific quantifiable measures for carrying out activities of daily living, have provided evidence of cost-effectiveness.

Using anti-TNF drugs and then measuring their effect on the ability to function has made it possible to define the level of response to treatment in terms of quality-adjusted life years gained (QALYs).

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

Other studies have begun to investigate the effect of TNF inhibitor treatment on employability; in one study, such treatment significantly improved employability and reduced the number of days missed at work.

In addition, ongoing studies are developing models that compare the outcomes of patients who can work productively versus what would happen in the case of progressive disease and lameness. A patient who does not have access to an anti-TNF drug and becomes crippled cannot be a positive producer for the economy. In addition, there would be a negative effect on the economy in terms of dollars needed for that patient’s health care.

Unfortunately, insurance companies that create barriers to the entry of these drugs have a very short-sighted view of the picture. Hopefully, further studies documenting the value to society and to the individual of remaining productive and having a better quality of life will change this situation for the better.