The New England Journal of Medicine has published a study suggesting that Enbril, the $4 billion RA drug, may not be worth the premium price. Researchers found they could match Enbrel’s effectiveness by combining sulfasalazine and hydroxychloroquine with methotrexate, which is a common RA therapy. They also compared this three-part combination to an Enbrel-methotrexate combination, which is not unusual. However what was not included in this study was the dire side effects of of sulfasalazine and hydroxychloroquine which could include liver toxicity and a whole range of other nasty side effects. The question that should be asked is not “which therapy is most inexpensive?” but which therapy provides “patients with a quality of life they expect while on treatment?”.
While the discussion around the costs of medications continues to take center stage most are failing to take into account which medications allow patients to lead a better quality of life via fewer side effects. Would you be willing to pay more for a medication that allowed you to lead a better quality of life ? My guess is that most would say yes but the FDA and most scientific studies don’t take patients quality of life into account because there is no way to measure quality of life and integrate the data into clinical trials.
The authors of this study have gained headlines suggesting that our healthcare system is paying way too much for Enbrel but their failure to ask doctors and patients about the two therapies when it comes to side effects and patients preferences is further proof that costs are surpassing patient preferences.