The Contribution of Biologics in Reducing Social and Economic Burden of Rheumatoid Arthritis
Date Issued
2010
Date
2010
Author(s)
Tai (Shannon Tai), Hsiao-Nan
Abstract
Biologics new drugs of world biotechnology industry got substantial investment and grew fast in recent years. Biologics for rheumatoid arthritis (RA) drew the attention because of its high prevalence rate as well as unmet needs for its treatment in the past. After the first biologic against RA was launched, the unresolved problem became resolvable because it (and other biologics) can effectively modify or stop disease progression. However, only minimal patient population is benefited by biologics in Taiwan. Before biologics entering the market, rheumatoid arthritis can not be well treated so that patient suffered from disease progression to joint erosion and narrowing, disability or joint replacement surgery. Now that these effective biological disease modifying anti-rheumatic drugs are already available, it might be worth to benefit more patients that subsequently mitigates social and economic burden.
Rheumatoid arthritis usually starts in people with age from 30 to 50 years old who should be at their productivity peak. The unemployment rate or reduced working ability is significantly more than that of the general population. Two-third of patients loses 39 working days a year in average; one-third of patients loses job and one-forth of patients’ income are decreased. Joint erosion starts in the early stage that 70% of patients have progressive joint erosion according to X-ray examination.
The method of this research is to conduct literature review and summarize the therapeutic outcome, disease burden and the social and economic improvement with biologics.
The key findings include that the values of biologics are higher than the conventional treatment and their indirect cost are also lower than the conventional treatment. As for the direct cost, if consider the long-term medical expenditure, biologics might not be higher than the conventional treatment.
The rheumatoid arthritis societies and leagues worldwide are advocating early treatment and treat-to-target. Based on these concepts, RA patients not only should be treated at early stage but those who have moderate to severe diseases also be included because these patients have higher possibilities to reach the treatment target, remission.
European League Against Rheumatism 2010 Recommendation points out that the standard mortality rate of RA patients is almost two times of the general population mainly because of the co-morbid cardiovascular diseases. The morbidity rate of cardiovascular diseases in RA patients is also higher. Hence, the disease activity of RA patients must be controlled in order to minimize their cardiovascular risks. Currently, a combination of any biologics of the anti-tumor necrosis factor category with methotrexate treatment showed the strongest evidence for reducing cardiovascular risks. Effective treatment of rheumatoid arthritis can improve physical function, increase mobility, decrease hypertension, hyperlipidemia, obesity and diabetes. American College of Rheumatology 2008 Recommendation recommended anti-TNF biologics for patients with moderate disease activity for 6 months or over, and for those who had inadequate response and with features of a poor prognosis that had received methotrexate monotherapy; as well as for patients with high disease activity, irrespective of the prognostic features.
Many advanced countries including Japan, US, France, Sweden, Spain, etc had already approved biologics for RA patients with moderate disease activity. It is worth to consider the inclusion of anti-TNF biologics for the aforementioned patients who failed to respond to the conventional disease modifying agents in the reimbursement system. This may bring more patients back to work that reduces social and economic burden, generates productivity, creates value and raises the overall economic benefits.
Subjects
Biologics
rheumatoid arthritis
DMARD
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