UK Rheumatologists Diverge From NICE Guidance on Costs

Research presented at the EULAR 2016 Congress showed that rheumatologists in the UK diverge from the National Institute for Health and Care Excellence’s (NICE) TNF inhibitor prescribing guidance when treating patients with rheumatoid arthritis (RA).

NICE guidance recommends that UK rheumatologists prescribe the cheapest available anti-TNF treatments to patients with RA.

“With so many factors for a consultant rheumatologist to consider when he or she is choosing which anti-TNF therapy to prescribe, this is likely to contribute to a wide variability in treatment received by RA patients in England,” study presenter Sean Gavan, PhD, of the Manchester Centre for Health Economics, UK, said in a press release. “Emergence of evidence, interpretation of clinical guidelines, patient involvement in decision making, desire for clinical autonomy, and the involvement of clinical service commissioners have all been identified as influencing factors.”

The researchers conducted individual, semi-structured interviews with 11 consultant rheumatologists from different hospitals in England. The interviews focused on key treatment decisions, including initiation of anti-TNF treatment, choice of first-line treatment, and remission treatment. The researchers used thematic framework analysis to determine trends in RA treatment decision-making.

Study results showed that cost was rarely a factor when making decisions related to first-line anti-TNF therapy, except when local commissions enforced NICE guidance. Furthermore, physicians expressed “cautious optimism,” regarding use of biosimilars simply for cost savings. 

Physicians also reported that they felt participation in treatment decisions was sacrificed when following NICE guidance. Additionally, some physicians reported feeling that NICE guidance was too restrictive, while others saw value in the flexibility it provided. 

“We now need further research to explore whether these deviations from NICE guidance lead to differences in patient outcomes, or cost-effectiveness of care,” Dr Gavan added.—David Costill