Biologic drugs for spondyloarthritis patients: do policies in different countries affect costs and health?
Scientific Study Title: Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates
Principal Investigator: Stephanie Harvard, University of British Columbia School of Population and Public Health PhD student and Arthritis Research Canada Trainee supervised by Dr. Bruno Fautrel, Pierre and Marie Curie University, Paris, and Dr. Aslam Anis, University of British Columbia School of Population and Public Health
Study Start Date: September 2014
Study End Date: September 2016
What was done?
SpA (short for ‘spondyloarthritis’) is a type of inflammatory arthritis that affects the back, hips, and often other parts of the body. The DESIR cohort is a group of 708 French SpA patients who are responding to follow-up questions about their costs and health. This study used information from DESIR to help understand more about policies around biologic drugs for SpA. Biologic drugs (also called ‘anti-TNF’ therapies) help stop inflammation from SpA, but they are expensive. Around the world, different countries have different policies around which patients should receive biologic drugs as a way to limit costs. This means a SpA patient in one country might receive a biologic drug, but a SpA patient in another country might not. Using information from DESIR, researchers looked at which patients satisfied the criteria to receive biologic drugs in different countries: France, Canada, Germany, the United Kingdom and Hong Kong. They used information about patients’ costs and health to try to understand whether the policy in France (where DESIR cohort patients are located) is the best policy for that country, or whether policies in other countries would be better at limiting costs and maximizing health.
What were the key findings?
The policies around biologic drugs for SpA that are in place in France, Canada, Germany, the United Kingdom and Hong Kong are different in important ways. Among patients in the DESIR cohort, 28% of patients satisfied France’s requirements for receiving a biologic. A similar number of patients satisfied the requirements in place in Germany (25%) and Canada (24%). Fewer patients satisfied the requirements in place in the UK (12%) and Hong Kong (9%). This study draws attention to how SpA patients in some countries would be less likely to receive a biologic than if they resided elsewhere.
The study found that France’s requirements for receiving a biologic may be leading to extra costs, without any added health benefit for patients, compared to the requirements in other countries. To know for sure, more research is needed. The study also showed that a lot of extra costs result when patients who are not benefiting from biologics continue to take the drug. One thing that patients and doctors can do together to save costs and improve health is to mutually decide to stop the biologic if it is not working.
Who was involved?
This study was led by a student researcher as part of a PhD thesis. A total of 7 researchers participated in the study.
Who funded this research?
To support her work with the DESIR Cohort, Stephanie Harvard received a Canadian Institutes of Health Research doctoral research award, two bursaries from the French Embassy in Canada, and a Michael Smith Foreign Study Travel award. This specific part of the study also received grant funding from the Spondyloarthritis Research Consortium of Canada (SPARCC), which was held by Dr. Aslam Anis.
Harvard S, Guh D, Bansback N, Richette P, Saraux A, Fautrel B, Anis A. Access criteria for anti-TNF agents in spondyloarthritis: influence on comparative 1-year cost-effectiveness estimates. Cost Eff Resour Alloc. 2017 Sep 7;15:20. doi: 10.1186/s12962-017-0081-8. eCollection 2017.