Managed Care Outlook
With a growing population, the prevalence of systemic lupus erythematosus (SLE) cases in the United States is expected to rise. Datamonitor compiled epidemiologic prevalence data for seven countries — the United States, Japan, France, Germany, Italy, Spain, and the United Kingdom. The largest increase in SLE cases is expected here in the United States, especially in the population most affected by SLE, namely women ages 15–44.
Coincidentally, the FDA approved a new medication for SLE, belimumab (Benlysta), on March 9.
“There hasn’t been a drug aimed at the pathogenesis of lupus until now,” says Sandra C. Raymond, president and CEO of the Lupus Foundation of America.
Raymond advises clinical executives at health plans that patients with lupus “finally have a treatment that targets the disease. Many drugs used in rheumatoid arthritis were tested for lupus in clinical trials, but they mostly did not work in lupus.”
The clinical studies in support of the approval for Benlysta hinted at a “steroid-sparing effect,” she notes. “In people with lupus, high doses of steroids have been used to tamp down the symptoms over long periods.
“But the negative effects of corticosteroid use include bone fractures, osteoporosis, and various bone replacements.” If long-term corticosteroid use can be avoided, insurers may save money in the long run.
She hopes that the drug will not be considered as a high-tier addition to the insurer’s formulary. Raymond points out that “lupus patients eventually go see the specialist — the rheumatologist — and the rheumatologist, not the primary care physician, is going to decide if the drug is appropriate for the patient — or not.”
Modest rise projected in lupus cases worldwide
The Centers for Disease Control and Prevention (CDC) is conducting a comprehensive study of the prevalence and incidence of lupus. The study includes all populations affected by lupus and almost all forms of lupus. Findings will be available early in 2013.
Source: Datamonitor, 2011
MANAGED CARE April 2011. ©MediMedia USA