There is a revolutionary new arthritis drug on the market, but some South African medical schemes seem unwilling to pay for it.
A ground-breaking new class of drugs, known as biologics, offers the hope of partial or complete remission to people with previously incurable systemic arthritis diseases like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile arthritis.
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However, they are being blocked by a few of the major SA medical schemes, although they are routinely prescribed for both children and adults by the NHS in Britain.
RA a debilitating disease
Affecting approximately 1% of any population group worldwide, rheumatoid arthritis (RA) can manifest in children from as young as two years and up. In adults, the disease usually starts between the ages of 25 – 50, disabling sufferers in the prime of life, causing pain and deformity, and necessitating lifelong treatment, hospitalisations and often joint replacement operations.
Described by rheumatologists as ‘miracle’ drugs, biologics target individual molecules called cytokines which are involved in the complicated process of inflammation. Data on patients taking biologics within three to six months of the onset of the disease showed that 40% went into remission after using biologics for 12 months. Children and adolescents could achieve complete remission if biologics were prescribed within three to six months of disease onset, with biologics not only halting, but completely turning off the disease process.
Biologics routinely prescribed elsewhere
Forty percent of American RA patients are now on biologics. In Sweden, biologics are routinely prescribed as the first line of choice for the early treatment of RA, within three to six months of disease onset. The use of biologics in treatment-resistant cases of RA has become standard recommended practice in developed countries, but South Africa lags far behind with only 300 users at present out of an estimated 450 000 sufferers.
The downside, unfortunately, is price. Biologics are expensive and cost an average of R10 000 per month at the outset of treatment. Discovery funded biologics until late 2005, but is no longer approving new applications for these drugs. Due to an increase in applications for biologics in 2005, they now argue that biologics are not cost-effective at the current price.
Biologics don’t come cheap
However, “Biologics have been shown to be cost-effective in overseas studies and there is a very limited demand for these drugs in South Africa,” says Dr Ingrid Louw, chairman of the SA Rheumatism and Arthritis Association (SARAA). She points out that biologics can only be prescribed by rheumatologists and according to very strict criteria. “There should be no problem funding them according to the terms outlined by SARAA,” she says.
A-rated biochemist , Prof Jannie Hofmeyr of Stellenbosch University, is a psoriatic arthritis patient who “got my life back” when prescribed biologics. He points out that not every RA sufferer is a suitable candidate for biologics. “Ideally, they should be prescribed to children and adults within three to six months of disease onset and to patients who have not responded to other treatments,” he says.
“Another cost-limiting mechanism is the fact that patients are only kept on a biologic if they respond to it,” says Prof Hofmeyr. Furthermore, the cost drops significantly over time in many cases and when children go into complete remission, it is also possible to wean them off biologics entirely.
Where do medical schemes come into the picture?
“Medical schemes that refuse to fund biologics are giving their patients the same choice in medication as that available to indigent patients in the public sector,” says Dr Louw. “However, medications are the most important part of RA treatment. So paying top dollar for a top medical plan does not necessarily give you top medications, and thus the chance of remission or significant relief.”
After the Herceptin debate, Discovery stated that it was in discussion with the Department of Health and a number of medical schemes on the establishment of an independent body to provide guidance to the SA healthcare industry on funding of new healthcare technologies.
“There has been no further public announcement of progress in the formation of this committee, nor has any arthritis patient group been approached for its input,” says Aletta van der Watt, CEO of the Arthritis Foundation.
Getting the price of biologics down
Will the price of biologics come down? Although the manufacturing process is lengthy and expensive, the SA Biologics Support and Advocacy Group (SABIO) points out that for the last six years the price of the drugs has not dropped in South Africa, despite considerable strengthening of the Rand.
“Perhaps pharmaceutical companies should consider reducing profits as a humanitarian gesture,” suggests van der Watt.
Dr Louw is somewhat optimistic about the long-term prospects. “The price of biologics is likely to drop in the future due to the great advances in research and at least ten more agents being in various stages of development,” she says.
(Press release from the Arthritis Foundation in South Africa)
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