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an Economist Intelligence Unit business healthcare

Helping commissioners predict the cost of new biologic drugs

October 18th 2010

Introduction

For clinicians and patients biologic drugs have revolutionised the treatment of many hard-to-treat conditions like rheumatoid arthritis (RA), psoriasis and Crohn’s disease. Severe flare-ups of these disabling diseases often lead to prolonged stays in hospital but such episodes can now be better managed with biologics: e.g. adalimumab, etanercept, and infliximab. However such benefits come with potential downsides. There are some adverse events associated with biologics and they are also very expensive. Balancing the pros and cons requires careful consideration of multiple points of view; it also requires that decision makers be informed by the highest quality evidence.

Nationally about 6% of patients with RA are currently taking biological therapies, and this is set to increase. Increasing demand means rising costs and the local bill for these drugs across their indications is reported to be increasing at 20% to 28% per year. It is unclear what the final proportion treated or the total annual cost might be once those eligible for biological therapies are taking them. There are limited resources available to forecast the potential effects of changes to the clinical pathways on overall treatment costs.

The project

Bazian was commissioned in July 2010 to conduct a rapid assessment and review of the cost and budget impact of the increasing use of biological therapies for RA in the East Midlands and to develop a tool that would model the effects of prescribing changes on overall cost of treatment. Unrestricted use of biological therapies would, of course, be unaffordable. But there is a potential to promote the rational use of these drugs in a way that generates maximum benefits to patients while making best use of limited NHS resources.

The targeting of therapies to those most in need will become an increasingly important part of rational healthcare in the near future. In order to better understand the budgetary impact of alternative prescribing patterns, we built an interactive tool underpinned by a Markov model that incorporated client and national data, current eligibility criteria, and reported “start, stop, and switch rates”, as published by the British Society of Rheumatology (BSRBR cohort study). Models are only as good as their underlying assumptions, and as such our assumptions were presented to a meeting of rheumatologists, public health specialists, commissioners, and pharmacists for validation and discussion. This aspect of model validation, working directly with our clients is a critical part of the way we work at Bazian. A commitment to ensuring that their input and feedback was incorporated into the model also ensured their “buy-in” on the process as a whole.

Some of the results from the model are shown below in Figure 1 (Estimated increase in treated patients over15 years for two PCT populations) and Figure 2 (Estimated increase in cost over next 15 years for two PCT populations).

Outcomes

The model is interactive and allows rheumatologists, public health specialists, commissioners, and pharmacists to test the budgetary consequences of ‘what if’ changes to the pathway of care. Other benefits were that:

  • age/sex adjusted models of prevalence and incidence of RA to facilitate discussions of potential need for the biologics
  • the model helps make a case for change in how budgets are currently set, these drugs will clearly become unaffordable
  • the model enabled a discussion of options for improving the pathway of care (for example earlier use of combination DMARDs)