News in brief: Biologics for RA responsible for only modest decline in hospitalisations; Telehealth MBS items now available for hospital inpatients; Sleep therapy provides relief of chronic OA pain 

Thursday, 23 Sep 2021

Biologics for RA responsible for modest decline in hospitalisations

Conventional therapy, not biologics, has contributed most to the significant decline in hospitalisations for patients with rheumatoid arthritis (RA) over time.

A WA study analysed 50,353 hospital admissions for 17,125 RA patients and state-specific dispensing data for conventional and biological therapies between 1995 and 2014.

It found the number of RA admissions fell between 1995 and 2002 – from 7.9 to 2.6/1000 admissions – while conventional therapy use rose from 1.45 to 1.84 DDD.

After biologics were first subsidised on the PBS in 2003, RA admissions decreased further to 1.9/1000 hospital admissions in 2014. Conventional therapy use increased to 2.19 DDD and biological therapy from 0.01 to 1.0 DDD during this period.

The study found the annual costs of biological therapy utilisation was 22.5 million while the annual cost saving of RA hospital admissions was 9.2 million.

It concluded biologics were not as cost-effective as conventional DMARDs in relation to RA hospital admissions costs.

Read more in Pharmacoeconomics

Telehealth MBS items now available for hospital inpatients

New MBS telehealth items have been introduced to cover in-hospital services for private admitted patients receiving specialist care where the doctor is unable to attend due to the COVID-19 pandemic.

Available from 15 September 2021, the 40 temporary items (valid until 31 December) for specialists cover video and phone consultations for a specialist who is located in COVID-19 hotspot, or in isolation or quarantine.

According to Medicare, private health insurance rebates and gapcover schemes do not apply for these telehealth attendances.

Out of pocket costs for the new items will count towards the patient’s Medicare Safety Nets (original and extended).

In its Factsheets, Medicare says MBS specialist telehealth items do not need to be bulk billed, although this is encouraged

“The fee structure for the new items aligns with equivalent face-to-face items and existing COVID-19 telehealth specialist items introduced from March 2020,” it says.

Sleep therapy provides relief of chronic OA pain

Chronic osteoarthritis pain can be relieved by treating a patient’s sleep problems with CBT, according to US research.

In a study involving 327 older adults (age 60+) with chronic OA pain and co-morbid insomnia, patients received six sessions of phone-delivered CBT over eight weeks, or education (control group). In patients who showed short term (two months) improvements in sleep after the intervention there were sustained (12 month) improvements in self-reported pain, depression, and fatigue compared to patients who did not show improvements in sleep.

The researchers concluded that the successful resolution of insomnia in OA patients may yield benefits not only for long-term improvement in sleep but also for reduced pain over the long-term.

Writing in the journal Sleep, they said this was an important finding given that analgesics such as NSAIDs and opioids used for OA pain “have clinically significant and potentially life-threatening adverse effects, particularly among older adults, and often less than desired analgesic efficacy.”

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