Seizing the Opportunity to Create Change in the Rheumatology Field
Pete Salzmann, MD, is the vice president of Immunology at Eli Lilly and Company.
Content sponsored by Lilly.
Although the origins of rheumatologic conditions, including arthritis, can be traced back thousands of years, rheumatology as a medical practice was only developed in the United States in the 20th century.1 Those early practitioners would be proud to see the progress we've made. At Lilly, we're proud, too, to be a part of this community, to support leading scientists and researchers, and to partner with organizations and institutions around the world, advancing our work and improving patients' lives every day.
The truth is, however, that to continue moving forward, the field of rheumatology (and those of us in it at Lilly and elsewhere) must find new solutions to today's challenges. These challenges include access to innovative medicines that is often difficult, the heavy burden rheumatologic diseases place on patients and their families, and the growing shortage of rheumatology professionals. Although we don't have all the answers, we're working hard to contribute to the solutions.
ACCESS TO INNOVATIVE MEDICINES THAT IS OFTEN DIFFICULT
It is critical for patients to have access to care and innovative treatments that could potentially help make a difference in their lives. However, it's a complex issue. Take step therapy, for example, which is a practice seen more and more in our health system, as financial pressures mount across the board. Despite what the physician prescribes, when a step therapy program is in place, patients are required to start with a specified medicine that is “on formulary” and wait until it fails before they can begin a nonformulary product, even if there's indication that it would benefit them more from the start.
To achieve good patient access in rheumatology, we need a variety of medicines from which physicians and patients can choose. Advanced therapies like anti-tumor necrosis factor (TNF) agents have been on the market a long time and are widely available. Although effective for some patients, there are others who do not respond to them or who see their benefits dissipate over time, requiring other options (that may or may not yet exist).
It's important for patients to have multiple treatment options available to best suit their disease characteristics and experience. In addition to developing treatments that can meet the unmet needs of patients, Lilly is working to help more patients access the treatments prescribed by their healthcare providers. We believe patients deserve to get to the right treatment for them as quickly as they can, because patients with progressive, rheumatic diseases don't always have the luxury of time.
REDUCING THE HEAVY BURDEN RHEUMATOLOGIC DISEASES PLACE ON PATIENTS AND THEIR FAMILIES
With arthritis being a leading cause of disability in the United States,2 the heavy burden arthritis and rheumatologic conditions place on patients — such as lost wages, high medical costs, physical pain, and stress — shouldn't come as any surprise. In fact, with an extra $140 billion of medical cost attributed to arthritis alone in 2013, the latest year for which data are available, the extra cost per adult with arthritis was $2117.3 And that's in addition to lost wages, which that same year totaled $164 billion, or more than $4000 less than is earned by someone without the disease.3
Effective and affordable treatment options are essential to controlling costs within the rheumatoid arthritis treatment space and delivering value to patients. One example of how Lilly aims to put patients first is with the list price of our rheumatoid arthritis treatment, as it was launched at a list price that is 60% less than the leading TNF inhibitor. We aim to deliver to patients and the health system by offering clinically meaningful disease control at a good value.
Although list price plays an important role in treatment access, other factors determine what a patient pays, including their personal health plan's benefit design and any financial obligations required in those plans. More needs to be done to reduce the financial and physical burden of these costly diseases for patients.
THE GROWING SHORTAGE OF RHEUMATOLOGY PROFESSIONALS
Any specialist in rheumatology knows that there just aren't enough of them to serve the demand of increasing patient needs in the United States. With just under 6000 adult rheumatologists and around 5000 rheumatology nurses, only around 270 of whom are nurse practitioners, it's becoming increasingly difficult to provide care for those who need it.4 In fact, there is an average of almost 49,000 adults per rheumatologist.4
Why the shortage? As the country's population ages, there's more demand than ever from patients experiencing rheumatologic disease and less supply of rheumatologists to care for them as they themselves age and begin to retire (with 10,000 Baby Boomers retiring every day5). Research suggests that by 2030 – less than 12 years away – the supply of rheumatologists will be half of what will be needed.6
Increasing the number of rheumatologists will require a concerted effort on many fronts. But it starts with education and encouraging emerging talent to enter the field. Together, we can create new and innovative methods to expand the workforce.
MOVING FORWARD TOGETHER
Although challenges exist, we believe that the rheumatology field is ripe with opportunity and promise to help people who are impacted by these devastating and progressive diseases. We're determined to work together with our partners and other stakeholders to make life better for people suffering from serious autoimmune conditions, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus, and others.
Whether it's through maintaining our commitment to developing novel medicines or improving the treatment experience, including patient access and care, we are optimistic about bringing innovation forward in the hope of reducing the burden of disease for people around the world.
1. Deshpande S. History of rheumatology. Med J DY Patil Vidyapeeth. 2018;7(2):119-123.
2. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013;21(9)1145-1153.
3. Murphy LB, Cisternas MG, Pasta DJ, Helmick CG, Yelin EH. Medical expenditures and earnings losses among US adults with arthritis in 2013. Arthritis Care Res (Hoboken). 2018;70(6):869-876.
4. 2015 Workforce Study of Rheumatology Specialists in the United States. American College of Rheumatology. Available at: www.rheumatology.org/portals/0/files/ACR-Workforce-Study-2015.pdf. Accessed October 11, 2018.
5. Heimlich R. Baby boomers retired. Fact Tank website. Available at: http://pewrsr.ch/T4o2Hs. Published December 29, 2010. Accessed October 11, 2018.
6. Davis J. Growing shortage of rheumatologists “very concerning.” Arthritis Foundation News Blog. Available at: http://blog.arthritis.org/news/growing-shortage-rheumatologists-arthritis-specialists/. Published February 20, 2018. Accessed October 11, 2018.