Of all the inflammatory joint diseases, psoriatic arthritis (PsA) is perhaps the most complex. Both a dermatologic and a rheumatologic condition, it’s like two diseases in one, making it painful, potentially disabling, and exceptionally hard to manage, says Paolo Cortesi, co-author of a study assessing the cost-effectiveness of biologic drugs for PsA. The disease may also contribute to a slew of comorbidities – namely heart disease, obesity, type 2 diabetes and high blood pressure.
Biologic drugs, made from living cells and typically administered through injection, have revolutionized the treatment of psoriasis and PsA, says Cortesi. Before the advent of biologics, most patients with PsA had one option: traditional disease-modifying anti-rheumatic drugs (DMARDs). Still the centerpiece of treatment for PsA, DMARDs continue to help many attain relief from pain and swelling, along with an improved quality of life.
“Traditional DMARDs remain an important aspect of treatment, but the impact of biologic drugs has been dramatic,” says Cortesi. “These novel drugs can slow or even halt structural damage to the joints and vastly improve physical function. We see them as significantly more effective than traditional DMARDs.”
They’re also expensive — so costly that they’re straining national health care budgets the world over. That’s why Cortesi and his colleagues at the University of Milano-Bicocca decided to tackle the twin issues of the drugs’ cost and cost-effectiveness via a literature review. Researchers pooled data from dozens of recently published articles on the economic burden of PsA and found that despite their high price tag, biologics are indeed a cost-effective treatment option.
The team published an earlier literature review in 2012. Their newest study, published in Pharmacoeconomics in February 2018, is an update, Cortesi says.
Direct and indirect costs
The researchers named biologics as the main driver of the total cost of treating PsA. But they also pointed to a different set of costs that make the disease unusually burdensome. Without effective treatment, people with PsA experience far higher rates of hospitalization, absenteeism and presenteeism (working while sick). The resulting loss of productivity turns out to be costly to patients, families, caregivers, the workplace and society as a whole.
These hidden costs have been rising in the context of an aging population and an increase in chronic diseases, Cortesi explains. “People are living longer generally, so ‘lifetime treatment’ can be very long indeed,” he says.
For some, these therapies succeed in slowing the disease progression to a crawl and buying people a high quality of life for years. For others, biologics may even halt disease progression altogether. The study’s authors acknowledge, however, that biologics won’t work for everyone. These drugs are less effective for some patients, while others cannot tolerate the side effects.
Still, the researchers maintain that biologics are cost-effective. To reach that conclusion, they went beyond the bean-counter approach to assessing cost and adopted a broader view.
The high cost of biologics, they argued, is at least partially offset by their effectiveness in improving patients’ quality of life and preventing damage to the joints long-term. In turn, these improvements translate into savings on the other side of the equation: lower rates of hospitalization, less absenteeism and presenteeism, and higher productivity, both at work and in the community. Economically speaking, productive individuals contribute more to society by way of taxes, consumption and the value of the work itself. These indirect savings, then, have a macroeconomic ripple effect beyond what’s measurable or countable.
The way forward
In many countries, cost-effectiveness research is increasingly used to inform health policy decisions, says Cortesi says. “Here’s the challenge: How many patients can you treat within the constraints of a national health care budget? And which drug is the most cost-effective? Not enough is known yet on the relative benefits of particular biologic drugs. We need to come up with a sequence of drug options, but the data aren’t yet there.”
Figuring out the best biologic treatment for each patient, he adds, depends on the evolution of “personalized medicine” — a still-emerging medical paradigm.
Another missing piece of the puzzle has to do with the burden of PsA on caregivers, which is “yet another hidden cost of this already costly disease,” Cortesi says.
As it stands, the study’s findings may encourage insurers and policymakers to take a longer, broader view of cost and help foster positive reimbursement decisions. And that would be good news for patients, society and everybody in-between.
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.