Has the use of disease-modifying anti-rheumatic drugs changed as a consequence of controlled access to high-cost biological agents through the Pharmaceutical Benefits Scheme?

Authors

  • C. Y. Lu,

    Corresponding author
    1. Faculty of Medicine, University of New South Wales and Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, New South Wales, Australia
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  • K. M. Williams,

    1. Faculty of Medicine, University of New South Wales and Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, New South Wales, Australia
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  • R. O. Day

    1. Faculty of Medicine, University of New South Wales and Department of Clinical Pharmacology and Toxicology, St Vincent’s Hospital, Sydney, New South Wales, Australia
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  • Funding: Christine Lu was supported by an Australian National Health and Medical Research Council postgraduate scholarship (grant number 351040).

    Potential conflicts of interest: A/Professor Ken Williams has been a member of the Advisory Board to the sponsor for adalimumab. Professor Ric Day is a member of the Advisory Board to sponsors for adalimumab, infliximab and anakinra in Australia. A/Professor Williams and Professor Day have also been contracted to undertake clinical trials of etanercept, infliximab, adalimumab and anakinra. Recompense for these activities is placed in audited hospital trust funds for use in the research activities of the Clinical Pharmacology Department, St Vincent’s Hospital, Sydney.

Christine Y. Lu, Therapeutics Centre, Xavier Building Level 2, St Vincent’s Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia.
Email: christine.lu@student.unsw.edu.au

Abstract

Background: A prerequisite for access to biological agents for the treatment of rheumatoid arthritis under Australia’s Pharmaceutical Benefits Scheme (PBS) is evidence of an adequate trial of conventional disease-modifying anti-rheumatic drugs (DMARDs). The aim of this study was to examine whether there were changes in prescribing DMARDs since the introduction of the PBS criteria for access to biologicals in August 2003.

Methods: A retrospective study was undertaken of the national use of DMARDs in the period before and after the introduction of biologicals under the PBS. Dispensing data were analysed for changes in patterns of DMARD prescription rates (2000–2005).

Results: There were 2 887 746 prescriptions for DMARDs between August 2000 and June 2005. PBS prescriptions accounted for 95% of these. Government expenditure for the DMARDs was $A156m. Trends in the use of DMARDs remained relatively steady over the study period without a significant change around the time the PBS criteria for biologicals were introduced. Use of hydroxychloroquine and leflunomide increased steadily, use of methotrexate and sulfasalazine was stable and use of gold preparations and penicillamine was considerably lower during this 5-year period.

Conclusion: Introduction of PBS criteria for access to biologicals did not alter the trends in use of DMARDs based on national dispensing data. This study emphasized the value that would accrue from availability of more comprehensive, de-identified, individual patient data that would enable more detailed examination of the use of medicines. These data are available, but cannot be easily accessed. It is time to make the data available for approved, ethical research in the interests of better outcomes from medicines supplied under PBS.

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