Physician treatment preferences in RA of differing disease severity and activity: The impact of cost on first-line therapy

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Arthritis Rheum 2002 Jun 15;47(3):285-90

Physician treatment preferences in rheumatoid arthritis of differing

disease severity and activity: The impact of cost on first-line therapy.

Erkan D, Yazici Y, on MJ, Paget SA.

Hospital for Special Surgery, Weill Medical College of Cornell

University, New York, New York.

Objective: To conduct a pilot study to identify rheumatologists'

treatment preferences for first-line rheumatoid arthritis (RA) therapy

and determine whether pharmacoeconomic variables modify physician

choice(s).

Methods: A questionnaire describing 3 different RA scenarios was mailed

to American College of Rheumatology members within 4 geographic regions

of the US. Physicians were asked to identify their choice(s) of

first-line therapy for each of the cases, first taking cost into

consideration, second without considering the influence of cost, and

third identifying the therapy that would be chosen for either themselves

or a family member.

Results: Three hundred seventy-five questionnaires out of a total of 994

(37.7%) were returned between 3/12/00 and 4/25/00. Hydroxychloroquine

was the most commonly cited medication for a mild disease

activity/severity presentation, and methotrexate for a

moderate-to-severe disease activity/severity presentation. For the

severe disease activity/severity presentation, when cost was not

considered, 217 (65%) rheumatologists included new disease-modifying

antirheumatic drugs (leflunomide, etanercept, and infliximab) in their

choice of first-line agents; this number decreased to 47 (14%) when cost

was a consideration.

Conclusion: Pharmacoeconomics appear to play a dominant role in

rheumatologists' choice of treatment regimens, at times contrary to the

physician's perception of the effectiveness of a drug. Future studies

should address physician preferences in more depth with respect to cost

and its various components.

PMID: 12115159