Rheumatoid Arthritis - New Therapies and Higher Costs

Mark Borigini, M.D. Health Pro
  • Rheumatoid arthritis is a chronic and progressive illness which has a large impact on those afflicted.  The destruction of joints can result in disability, and the illness itself can result in a shorter life span.  Untreated rheumatoid arthritis, therefore, has tremendous economic costs: (i) costs to society in time lost from the workplace and (ii) the costs to individual families should the illness be severe enough to limit income.


    Much attention is being paid to the cost associated with being diagnosed with rheumatoid arthritis because at some point we all must justify the cost associated with treating rheumatoid arthritis.

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    The development of tumor necrosis factor (TNF) inhibiting drugs (such as Enbrel, Remicade, and Humira) has allowed for a great improvement in rheumatoid arthritis treatment goals: remission is a very real possibility in a large percentage of rheumatoid arthritis patients thanks to these new agents.


    Unfortunately, the cost of these newer biologic agents can prevent some patients from having access to what could be a life-changing treatment.  In the United States, the average wholesale price for one year of therapy with either Enbrel or Humira in 2006 was about $16,000.  Remicade’s cost is more difficult to determine, as the dose can vary significantly, but the cost is generally thought to be similar to the other TNF inhibiting drugs.  The cost of these drugs are many, many times that of the older drugs.  For example, the average wholesale price for one year of generic methotrexate at 17.5 mg each week is $500.  And while methotrexate is thought to be inferior compared to the TNF inhibiting drugs, the terrible question we as a society must tackle is: Does the superiority of Enbrel or Remicade or Humira justify their significantly higher costs?  And if so, who should pay for these drugs?  If there are limited dollars for health care, do we spend the money to pay for these newer rheumatoid arthritis treatments, or can that money be better used elsewhere?  Should we all be paying higher health insurance premiums for an illness that affects only 1% of the population?


    There have been several studies addressing the cost effectiveness of the TNF inhibitors, and it appears that these drugs may indeed be economically cost effective.  Studies have shown improvement in work status with TNF inhibitors which does appear cost effective. 


    But studies which focus solely on work productivity may be biased against a large segment of the population suffering from rheumatoid arthritis.  This is because rheumatoid arthritis affects women more than men, and there is still a significant portion of the female population that does not work outside the home.  However, these patients contribute greatly to the economic well-being of their households, and the incapacity which could result from severe and uncontrolled rheumatoid arthritis can have a devastating impact, resulting in the need to hire domestic help, for example, and thus taking dollars out of the family savings for everything from tuition to orthodontics.

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    At this point, the cost effectiveness of the TNF inhibiting drugs appears to support their routine use, particularly in the more severe patient.  The challenge to the rheumatologist will continue to be trying to predict which patient will need these more expensive drugs.  Unfortunately, thus far science has not given us tools to predict which patient will do well with an older, less costly drug, versus, say, Enbrel.  This is the challenge the rheumatologist faces when he must decide whether a patient needs a drug which might cost hundreds of thousands of dollars over a lifetime versus one which might only cost a few hundred dollars each year--and be just as effective in that particular patient.

Published On: May 21, 2007