RA treatment costs expected to increase

June 1, 2001

Pharmaceutical Representative

New products for rheumatoid arthritis patients are expected to dramatically improve the treatment of this condition, but will also dramatically raise the cost of treatment, according to a new report by New York-based Datamonitor. The report also found that changes in the treatment of RA will cause therapy to begin earlier, to last longer and to be administered as combinations of drugs rather than monotherapies. The result of such changes will be a dramatic increase in the cost of RA treatment overall, increasing the strain on healthcare budgets.

New products for rheumatoid arthritis patients are expected to dramatically improve the treatment of this condition, but will also dramatically raise the cost of treatment, according to a new report by New York-based Datamonitor. The report also found that changes in the treatment of RA will cause therapy to begin earlier, to last longer and to be administered as combinations of drugs rather than monotherapies. The result of such changes will be a dramatic increase in the cost of RA treatment overall, increasing the strain on healthcare budgets.

The report also found that:


•Â Novel drugs for the treatment of rheumatoid arthritis can cost over 10 times more than current gold-standard therapies.


•Â The length of time a patient will take drugs is expected to increase as diagnosis and treatment improve.

All classes impacted

While the increase in the cost of drugs will impact both the non-steroidal anti-inflammatory drug and disease-modifying anti-rheumatic drug classes, the greatest impact will be in the DMARD class. This follows the introduction of three new products that have been launched with premium prices: Philadelphia-based Wyeth-Ayerst Laboratories' Enbrel® (etanercept), Malvern, PA-based Centocor Inc.'s Remicade® (infliximab), and Arava™ (leflunomide), from Parsippany, NJ-based Aventis Pharma AG.

With few major launches in the DMARD class over the last five years, the appearance of generic products, in particular methotrexate, has cut the cost of rheumatoid arthritis therapy. Methotrexate is the current gold-standard DMARD treatment and is available as a generic product at a cost of less than $0.25 per day in most major markets. In the United States, the cost of methotrexate treatment is approximately $0.80 per day.

In the United States, the costs per day for Arava and Remicade are $9.62 and $23.68, respectively. This represents a huge increase in the daily cost of treatment compared with generic methotrexate. However, the improved efficacy and side effects of these products are stimulating their use despite high cost, with future drug launches expected to follow this trend.

"The price of new products to treat rheumatoid arthritis represents a huge leap in the cost of treatment," said Datamonitor analyst Christopher Donnellan. "However, the improvements in treatment offered by these drugs are driving their use in spite of the high cost."

Length of time

Rheumatoid arthritis sufferers can expect to receive drugs at an earlier stage and for a longer period as improvements are made in both the diagnosis and treatment of this condition, the report found. In combination with increasing drug costs, the overall cost of treating a rheumatoid arthritis sufferer is expected to rise dramatically.

At present the diagnosis of rheumatoid arthritis is difficult, and across most of the major pharmaceutical markets the diagnosis rate is less than 80%. Diagnosis depends upon a number of criteria but no specific biological markers, making the diagnosis process difficult and lengthy. During this time, patients will not receive DMARD therapy due to the side effects of treatment. Improved diagnosis will therefore lead to a rapid increase in the number of patients receiving drugs, as patients are diagnosed faster and more accurately.

Advances in the treatment of rheumatoid arthritis are expected to improve the mobility and mortality of patients, increasing the length of time patients receive drug therapy. Improvements in therapy will revolve around the use of novel drugs and combinations of drugs, both of which will increase the overall cost of treatment.

Therefore, the cost of rheumatoid arthritis treatment will rise as patients receive therapy at an earlier stage and expect to receive drugs for a longer period of time. Considering the increased cost of drugs, overall changes in treatment costs could be huge.

"The cost of RA treatment will increase rapidly over the next seven years as patients receive drugs from an earlier stage and for longer periods," said Donnellan. "The increasing use of combination therapies will also increase the cost of therapy." PR