RA remission has economic benefits

People with RA gain economic as well as clinical benefits from being in remission, and this should be taken into consideration in reimbursement decisions for high cost drugs such as biologics, a review by Professor Andrew Ostor of Monash University has concluded.

The review based on 16 studies of RA found that remission (mostly defined by DAS28) was associated with 19–52% reduction in direct medical costs such as doctor fees and hospital visits, as well as tests and investigations compared with not achieving remission.

People with RA who achieved remission also had 37–75% savings in indirect costs such as through work productivity from disability, the study found.

“Although JAK inhibitors have higher treatment costs (approximately [US]$20,000 to $45,000 per year) than csDMARDs (e.g., methotrexate has an annual cost of $796), they may not only allow more patients to achieve better disease control but may also result in direct and indirect cost savings,” the paper noted.

“Thus, the cost-effectiveness and economic benefits of novel RA treatments, such as JAK inhibitors, would be underestimated if treatment costs alone are considered in economic evaluations,” the authors wrote in Advances in Therapy.

“These findings also underscore the importance of the treat-to-target strategy to achieve RA remission,” the review authors added.

Vagus nerve device aims for clinical trials in RA patients

Dr Evange Romas, head of the rheumatology unit at St Vincent’s Hospital, Melbourne is working closely with researchers at the Bionics Institute to start human trials of an implanted neuromodulation device that aims to manage rheumatoid arthritis by stimulating the vagus nerve.

According to the Bionics Institute, the rationale for the device is based on the vagus nerve sending an anti-inflammatory reflex response when inflammatory signals are detected in people with autoimmune conditions.

“By stimulating the vagus nerve, which controls the body’s anti-inflammatory reflex, we can dampen the inflammation to reduce the pain and stiffness and allow people with rheumatoid arthritis to move freely,” says Institute researcher Dr Sophie Payne.

Dr Romas said that if successful the device could become a treatment option in around 40% of RA patients who stop responding to drug therapy.

“This new treatment is incredibly exciting and I’m doing everything in my power to help the Bionics Institute researchers get it into the clinic for the benefit of my patients as soon as possible,” he said.

Institute researchers are aiming to set up human trials within two years, in which the battery powered thumbnail-sized device will be attached to the vagus nerve in the abdomen using keyhole surgery. The neuromodulation device is also being investigated for other autoimmune conditions such as Crohn’s disease.

Transparency register to reveal surgeon outcomes

A bill that will require surgeons and hospitals to be transparent about their surgical performance outcomes on a public register has had its second reading in Senate.

The Health Insurance Legislation Amendment (Transparent Patient Outcomes) Bill 2021 will establish Transparent Patient Outcomes registers for a range of medical specialties such as plastic, reconstructive and orthopaedic surgery, which its proponents say will allow consumers to make informed choices after viewing the performance of individual practitioners and patient outcomes for procedures they are poised to undergo.

Speaking on 23 November, Senator Stirling Griff said the transparency register will include information such as the number and type of surgical procedures performed by a practitioner, their surgical revision rate, their patient mortality rate, any prosthesis device they may use, patient data and any other information deemed relevant to that specialty. This information would also be available at the facility level.

“Such a database would provide objective comparable statistics and would provide prospective patients factual information through which they could exercise greater self-determination in their choice of practitioner (rather than relying on trust, assurance or referrals) and the database could also serve to reassure an anxious patient,” he said.