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23. Davies A, Cifaldi MA, Segurado OG, Weisman MH. Cost-effectiveness of sequential therapy with tumor necrosis factor antagonists in early rheumatoid arthritis. J Rheumatol. 2009;36:16-26. 24. Kobelt G, Lindgren P, Geborek P. Costs and outcomes for patients with rheumatoid arthritis treated with biological drugs in Sweden: a model based on registry data. Scand J Rheumatol. 2009;38:409-418. 25. Brennan A, Bansback N, Nixon R, et al. Modelling the cost effectiveness of TNF-alpha antagonists in the management of rheumatoid arthritis: results from the British Society for Rheumatology Biologics Registry. Rheumatology (Oxford). 2007; 46:1345-1354. 26. Benucci M, Li Gobbi F, Sabadini L, et al. The economic burden of biological
therapy in rheumatoid arthritis in clinical practice: cost-effectiveness analysis of sub-cutaneous anti-TNFalpha treatment in Italian patients. Int J Immunopathol Pharmacol. 2009;22:1147-1152. 27. Breedveld F. The value of early intervention in RA—a window of opportunity. Clin Rheumatol. 2011;30(suppl 1):S33-S39. 28. Augustsson J, Neovius M, Cullinane-Carli C, et al. Patients with rheumatoid arthritis treated with tumour necrosis factor antagonists increase their participation in the workforce: potential for significant long-term indirect cost gains (data from a population-based registry). Ann Rheum Dis. 2010;69:126-131. 29. Solomon DH. The comparative safety and effectiveness of TNF-alpha antagonists [corrected]. J Manag Care Pharm. 2007;13(1 suppl):S7-S18.
Stakeholder Perspective Assessing the Value of TNF-Alpha Blockers for Patients with Rheumatoid Arthritis By Michael S. Jacobs, RPh Vice President, National Accounts, Truveris, Inc, New York, NY
Modern pharmaceutical therapies, such as tumor necrosis factor (TNF)-alpha blockers for patients with rheumatoid arthritis, have approached being perceived as “magic” for many patients with this condition and their physicians. PAYERS: These therapies, however, often exceed tens of thousands of dollars annually in cost on a per- patient basis and are therefore a difficult “sale” to payers of all types (with the possible exception of the government), who are concerned with the value of the investment itself, or at least with the alternative value that can be purchased for this substantial financial investment in an individual’s healthcare. When health plan sponsors examine the impact that TNF-alpha blockers have in the more global context of payer thought and decision-making processes, such as budgeting, the coverage rules and coverage decisions become even murkier for payers. When the relatively improved clinical efficacy associated with these therapies is compared with the efficacy of substantially less expensive alternate therapies, and with the “value” that is being purchased, appropriate cost-sharing burden levels become a true concern for all stakeholders—payers, patients, and family members. And when all of these dimensions of therapy and coverage components are combined, these questions not only concern the patients themselves but also the impact these issues have on family members, coworkers, and, of course, plan sponsors. All of this “noise,” regretfully, can obscure the identified and promised clinical value of the therapy with TNF-alpha blockers. PATIENTS/PHYSICIANS: According to the study
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presented by Nair and colleagues, patients with rheumatoid arthritis who were receiving TNF-alpha blocker therapy were found to have lower odds of being unemployed compared with nonusers of this therapy who had moderate or severe disease. From a patient (and most likely a physician) perspective, this therapy is a significant advancement in the treatment of rheumatoid arthritis. From a cost perspective, the payer will need to address a number of questions, such as, “Would this patient be employed even with this therapy?” or “Is the economic value of the employment reasonable when the cost of the employment, including therapy, combined with the other costs of employment, such as wages and taxes, is calculated?” EMPLOYERS: Employers, who are often the health plan sponsors themselves, pay wages based on a number of considerations and variables, including the value received for the work effort performed and the financial compensation paid. According to the Bureau of Business and Economic Research at the University of New Mexico, the average annual wage in the United States in 2011 (preliminary estimate) was $48,301.1 If we add to this amount the cost of expensive therapies, such as those identified in the present study, the question now becomes, “Is this employee worth the total cost of employment?” This is one question that should be addressed in the near future, as these expensive therapies become more common within the healthcare system. n 1. Bureau of Business and Economic Research. Annual average wage/salary disbursements per job, U.S. and States 2000-2011. Revised October 12, 2012. http://bber. unm.edu/econ/us-wage.htm. Accessed April 9, 2013.
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