News about Rheumatoid Arthritis Treatment Options
Cost-effectiveness and Rheumatoid Arthritis treatment options
An April 28, 2010 editorial in Arthritis Research and Therapy discusses a study published in March. Scott and Kingsley write, “Doubts about the relative benefits of TNF inhibitors have surfaced in early RA.” This study and other recent data have caused them to doubt the relative “cost-effectiveness” of Biologic therapy as a treatment option in early RA. They illuminate the new study called The loss of health status in rheumatoid arthritis and the effect of biologic therapy: a longitudinal observational study as saying that “cost effectiveness of TNF inhibitors may be overestimated.” They say that alternative treatment options with Biologics ought to be explored which might be more effective and more cost-effective. “For example, short courses of Biologics during flares may be as effective as long term use.”
“New data from Wolfe and Michaud question the widespread use of TNF inhibitors in established RA… (They) conclude that TNF inhibitors may provide only modest incremental benefits over best conventional therapy as currently used in North America. If they are correct, the economic argument underpinning the widespread use of TNF inhibitors in established RA is unsustainable.”
Do research
ers Wolfe and Michaud want to change options for Rheumatoid Arthritis treatment with regard to Biologics? I’m not sure. We can each read it and see for ourselves. Here’s one quote from their conclusion: “The estimated incremental 10-year total direct medical cost for this benefit (Biologic therapy) was $159,140. Biologic therapy retards RA progression, but its effect is far less in the community than is seen in clinical trials. Consequently, cost-effectiveness is substantially less than that estimated from clinical trial data.”
A flare-specific Rheumatoid Arthritis treatment option?
At one point, I thought I had gotten the message “early and aggressive” treatment, including the possibility of Biologic therapy, is the best of all Rheumatoid Arthritis treatment options. Great to know, I thought. All we have to do is get the word out to every patient. Then, I realized many doctors were still using the old pyramid approach to treating Rheumatoid Arthritis. Great to know the score, I thought. All we have to do is teach the doctors. Then, I read this: “widespread use is unsustainable.” Where are we now? All we have to do is convince the researchers? Hopefully not.
What’s so wrong with only treating Rheumatoid Arthritis aggressively during flares? How about providing us an objective measure of a Rheumatoid Arthritis flare, for one thing? In the last few weeks, several patients have told me stories with a version of this scenario: External joint swelling and inflammation markers were reduced, while symptoms of joint pain, weakness, and stiffness continued. The rheumatology doctors told these patients that a modified diagnosis or reduced treatment plan may be in order. In each case, the stunned patient planned to find a new doctor.
Speaking of Rheumatoid Arthritis treatment options…
Tomorrow is my regular four-month check up with the rheumatology specialist. Here I am trying to finish up the blog early enough to get myself well rested so I will look bright and presentable at the appointment. It’s conventional wisdom that professionals treat folks better who look respectable, so I always put my best foot forward – as crooked as it may be. Maybe I shouldn’t try so hard not to look sick.
Recommended reading:
- Is there a blood test for Rheumatoid Arthritis? Part 1
- Pyramid Approach to Rheumatoid Arthritis Trashed
- Rheumatoid Arthritis Swelling: My Confession
- What is a Rheumatoid Arthritis Flare?
Here in the UK you have to had failed with at least 2 DMARs before they will let you try out any of the biologics. Personally I went through MTX tablet’s and then Avara before they let me try out Humira. The MTX tablets were causing too many mouth problems and the Avara was causing liver problems. We still have the Pyramid approach here. Plus if you fail on one Anti TNF they say you cannot try another, so although Humira stopped working I cannot try Enbrel. These are set by ‘NICE’ a government body who oversee prescription medicines. I’m now on Rituximab, and MTX injections as I asked the rheumy about trying them as the Rituximab does seem to work better alongside MTX.
Interesting study Kelly..
:chic: Thanks for that info, Jakki. It really helps people to compare.
I actually think this might all have to do with our new Obama care thing. I believe that if it cost too much and we aren’t “some one of importance”Then our treatments will be stopped!If the only time they will treat Flares with high dose meds then how will we keep from having flares and damage!!The world is going to HE** in a hand bag. They should stop the darn drug companies from charging so much money for these drugs.!!! We all know it doesn’t cost that much to make them. Or maybe that’s what they think they will be doing?? If no one uses those drugs as much then they will lower their prices?? I wish just once they could feel our pain and then lets see how much they would think we DONT need these drugs??They should have had a cure or at the very least come up with a cause for RA buy now with all the so called research they have done??Im sorry but this stuff just BURNS ME UP!!!! Could u tell?? LOL
I hope not, but it’s hard to hear them say how cost is important to these policies, isn’t it?
I was diagnosed with RA ten years ago at age 40. I had early and severe damage. I have been self injecting both Methotrexate and Enbrel for the past 9 years. I did not want to look back and regret not having done everything I could for myself and my family. I eat right, take my vitamins and exercise as directed by my physiotherapist and doctor. The exercise is key, strong muscles make up for damaged joints. Good nutrition is important, inflamation burns muscle you must eat well to rebuild. My weight is good.
I am told I will probably always have flares but the disease has been slowed. My Rheumatologist is “delighted” with how well everything has worked. Early intervention does work.
I’m glad “early & aggressive” worked so well for you Joanne. I hope it remains available to other new patients until there is a cure. 🙂
This article is a bit upsetting to me. The insurance companies will jump all over this…using it as a justification to deny paying for certain treatment options. And I will admit that I haven’t read the 1000+ pages explaining the new “Obamacare”…but I have heard that there will be decisions made (by whom, I’m not sure) about an individual’s care and what will be paid…. probably kind of like what someone here described…was it Jakki?…about not being able to try Enbrel because Humira did not work for her (in the UK). Bottom line….this is not good news for us. Yes, the biologics are expensive, but it takes many years (5-10, I believe) and many millions and billions of dollars to research, develop, and test these drugs before they are offered to the general public. And, yes, the pharmaceutical companies are in business to make money, but you can’t blame them for that. What is sad is that all of us unfortunate people who have this disease will be treated as less-than-human….denied the right to try a medicine because it wouldn’t be “cost-effective” to do so. How do you place a value on a person’s “health” and who has the right to decide, for example, that it wouldn’t be “cost-effective” to spend a few thousand dollars for a patient to try another medication with the hope that it might give that person some relief or possibly remission? It angers me to think that I might be denied the opportunity to try a biologic treatment for RA….one that could possibly give me excellent results! Am I supposed to sit here the rest of my life….becoming increasingly disabled….and NOT be afforded the CHOICE to try a medication???…. Because it wouldn’t be COST-EFFECTIVE???? Sorry, but this is just wrong.
Yea, I didn’t feel too happy reading this, either. From what I learned in college “cost effective” isn’t even a real word. Ha!
I think this has nothing to do with health care reform. My insurance company, when I was first diagnosed four years ago, made me go though three DMARDS until I qualified for biologics.
If I had still been an expat in Australia, I would have been able to start with biologics without needing to try three DMARDS first.
I think that we will get better care, without spending hours on the phone with insurance companies, (right now my insurance company is refusing to pay for my Cimzia even though they pre-approved it and my Doctor is refusing to give me another injection until they pay because his practice cannot afford to carry the cost) when health care reform kicks in.
That’s right Anj, currently in the US, it depends on the coverage you have. But in some countries, there is a universal policy. I hope the Cimzia gets straightened out. I went through that recently and discovered it was actually human error on our company’s end. :silly:
I am appalled that finances are going to determine the treatment protocols. Only with the addition of biologics did my RA go into remission. So much so I thought I was cured and stopped it. Of course unrealistic thinking. Sounds simililar to the breast mammogram controversy over the age to begin routine mammograms forgetting about all the lives that have been saved for women in their forties but just looking at the overall cost benefit. For me, my doc is now going back to the standard DMARD approach prior to the biologic which I am not real happy about. But it is only for one month I hope before the biologic begins and works as before.
I love the thoughts about looking your best, not sick, and where does that get you. Kudos for noticing this controversy on standard protocols for treatment of RA and the possible denial of expensive treatment.
Linda, I was also thinking that it was like the mammogram controversy about “cost effectiveness.”
I just came from my appointment and now worries – I did not look very good. 😉
Like in the UK, here in NZ we have to fail conventional DMARD triple therapy before we can start biologics. I’m on prednisone, methotrexate and sulfasalazine which together are just starting to work (thank God) after nearly 6 months. Otherwise I would then have to add either Avara or Plaquenil and wait for that to fail too. The first choice (and I think only as its the only one the doctor has mentioned) of biologic here is Humira. Our government funder is called Pharmac and they call the shots. I have private health insurance but they won’t even consider it. I’m grateful the DMARDs seem to be working finally but would prefer to have the best treatment options available.
Joye, thanks for the info. about NZ. Does the prednisone count as one of the three in the triple therapy? Do they expect that you will use it long term?
There was rumor on tv tonight, from a democratic senator from Ohio that one of the ways Obama will try to save money, via health care, and to help bring the deficit down, is by fighting to get GENERIC BIOLOGICS for seniors on Medicare. Hope that one pans out!
It seems we have toddlers practicing medicine on us. What about the days of missed work and the piling up of household chores, what about our childrens needs? Most of us must wait days or weeks just to get in to see our Doctor. A flare can last weeks. The TNF blocker injection can take weeks to begin working. This is insane politics.. No thank you to who ever came up with this method. Obviously they dont have RA so they can’t possibly understand and be objective at all.