For elderly and disabled rheumatoid arthritis (RA) sufferers, the Medicare Prescription Drug Improvement and Modernization Act (MMA) brought the promise of better disease management with "biologic" drugs.
Prior to its passage in 2006, Medicare covered only one of the tumor necrosis factor á (TNFá) inhibitors, the infusion drug infliximab, also known by its brand name, Remicade. Since the MMA, most Medicare prescription drug plans offer coverage of the anti-TNFá self-injectables etanercept (Enbrel) and adalimumab (Humira), as well as the interleukin-1 receptor antagonist anakinra (Kineret). More effective at controlling the painful and crippling symptoms of RA than conventional disease-modifying antirheumatic drugs (DMARDs), biologic drugs are also more expensive. According to a recent study, this new class of therapies has increased the cost of treating a patient with RA in the United States 3-fold.
To help Medicare beneficiaries and their providers select the best-value treatment option, a team of researchers, supported by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, developed a mathematical model to estimate the costs and benefits of etanercept, adalimumab, and anakinra compared with those of infliximab over a patient's lifetime. Their results, featured in the April 2008 issue of Arthritis & Rheumatism (www.interscience.wiley.com/journal/arthritis ), make a case for coverage of either etanercept or adalimumab over infliximab. In terms of effectiveness, the 3 TNFá inhibitors are nearly equal. Getting the same results with infliximab, however, requires paying more—roughly $13,000 more—per patient. Anakinra is substantially less costly than the anti-TNFá drugs but also less effective.