British Bureaucracy Stymies Use of TNF Inhibitors

Nearly half of British rheumatologists report that they are unable to prescribe approved drugs for rheumatoid arthritis patients because of financial caps and other constraints placed by their local National Health Service trusts, according to a recent survey.

Rheumatologists reported barriers to prescribing infliximab and etanercept for rheumatoid arthritis patients meeting the guidelines set forth by the National Institute for Health and Clinical Effectiveness (NICE). NHS trusts in England and Wales are required to provide any drug or treatment meeting NICE's clinical and cost-effectiveness standards (Rheumatology 2006 Oct. 11 [Epub doi:10.1093/rheumatology/kel333]).

The survey's authors, Dr. Lesley Kay and Dr. Ian Griffiths, of the musculoskeletal unit at Freeman Hospital in Newcastle-Upon-Tyne, England, sent questionnaires to all 509 consultant rheumatologists who were members of the British Society for Rheumatology. A total of 136 responses on behalf of 252 consultant rheumatologists were received.

Despite NICE's guidelines, 56 of the returned questionnaires, or 42%, representing 115, or 46% of the rheumatologists covered, reported some type of limit on anti-tumor necrosis factor-α therapies such as infliximab or etanercept, the authors wrote.

Of those reporting limits, 40 said they were in the form of caps on funding or the number of rheumatoid arthritis patients allowed the treatment, 12 reported limits on staffing to meet patient needs, and 4 reported lack of other facilities. Forty-eight respondents also reported a waiting list for such therapies, according to researchers.

Ninety respondents said they are able to prescribe anti-tumor necrosis factor agents for ankylosing spondylitis or psoriatic arthritis in at least some circumstances, leaving 33% of consultant rheumatologists unable to prescribe the therapies for those patients, the researchers wrote.

“The fact that different funding organizations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live,” the authors said. “Long waiting times for patients to receive these drugs once a decision to prescribe has been made are not uncommon, which will add further to their deterioration and compromise their likely outcome.”

The organization representing NHS trusts would not comment directly on the survey, but did defend the decisions of its members. “[Primary care trusts] receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities,” Nigel Edwards, director of policy at the NHS Confederation, said in a written statement.

“For example, this year many PCTs have been faced with decisions about spending money on expensive drugs and cutting waiting lists.

“The decisions that PCTs take are informed by professional executive committees made up of doctors and nurses, as well as managers,” Mr. Edwards said. “These committees decide what the local priorities are, and, as every community is different, it is not surprising that they often reach different decisions.

“Many primary care trusts also have active ways of engaging their communities in the decisions they make, and naturally, communities will have different views and priorities themselves.”

Nearly half of British rheumatologists report that they are unable to prescribe approved drugs for rheumatoid arthritis patients because of financial caps and other constraints placed by their local National Health Service trusts, according to a recent survey.

Rheumatologists reported barriers to prescribing infliximab and etanercept for rheumatoid arthritis patients meeting the guidelines set forth by the National Institute for Health and Clinical Effectiveness (NICE). NHS trusts in England and Wales are required to provide any drug or treatment meeting NICE's clinical and cost-effectiveness standards (Rheumatology 2006 Oct. 11 [Epub doi:10.1093/rheumatology/kel333]).

The survey's authors, Dr. Lesley Kay and Dr. Ian Griffiths, of the musculoskeletal unit at Freeman Hospital in Newcastle-Upon-Tyne, England, sent questionnaires to all 509 consultant rheumatologists who were members of the British Society for Rheumatology. A total of 136 responses on behalf of 252 consultant rheumatologists were received.

Despite NICE's guidelines, 56 of the returned questionnaires, or 42%, representing 115, or 46% of the rheumatologists covered, reported some type of limit on anti-tumor necrosis factor-α therapies such as infliximab or etanercept, the authors wrote.

Of those reporting limits, 40 said they were in the form of caps on funding or the number of rheumatoid arthritis patients allowed the treatment, 12 reported limits on staffing to meet patient needs, and 4 reported lack of other facilities. Forty-eight respondents also reported a waiting list for such therapies, according to researchers.

Ninety respondents said they are able to prescribe anti-tumor necrosis factor agents for ankylosing spondylitis or psoriatic arthritis in at least some circumstances, leaving 33% of consultant rheumatologists unable to prescribe the therapies for those patients, the researchers wrote.

“The fact that different funding organizations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live,” the authors said. “Long waiting times for patients to receive these drugs once a decision to prescribe has been made are not uncommon, which will add further to their deterioration and compromise their likely outcome.”

The organization representing NHS trusts would not comment directly on the survey, but did defend the decisions of its members. “[Primary care trusts] receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities,” Nigel Edwards, director of policy at the NHS Confederation, said in a written statement.

“For example, this year many PCTs have been faced with decisions about spending money on expensive drugs and cutting waiting lists.

“The decisions that PCTs take are informed by professional executive committees made up of doctors and nurses, as well as managers,” Mr. Edwards said. “These committees decide what the local priorities are, and, as every community is different, it is not surprising that they often reach different decisions.

“Many primary care trusts also have active ways of engaging their communities in the decisions they make, and naturally, communities will have different views and priorities themselves.”

Nearly half of British rheumatologists report that they are unable to prescribe approved drugs for rheumatoid arthritis patients because of financial caps and other constraints placed by their local National Health Service trusts, according to a recent survey.

Rheumatologists reported barriers to prescribing infliximab and etanercept for rheumatoid arthritis patients meeting the guidelines set forth by the National Institute for Health and Clinical Effectiveness (NICE). NHS trusts in England and Wales are required to provide any drug or treatment meeting NICE's clinical and cost-effectiveness standards (Rheumatology 2006 Oct. 11 [Epub doi:10.1093/rheumatology/kel333]).

The survey's authors, Dr. Lesley Kay and Dr. Ian Griffiths, of the musculoskeletal unit at Freeman Hospital in Newcastle-Upon-Tyne, England, sent questionnaires to all 509 consultant rheumatologists who were members of the British Society for Rheumatology. A total of 136 responses on behalf of 252 consultant rheumatologists were received.

Despite NICE's guidelines, 56 of the returned questionnaires, or 42%, representing 115, or 46% of the rheumatologists covered, reported some type of limit on anti-tumor necrosis factor-α therapies such as infliximab or etanercept, the authors wrote.

Of those reporting limits, 40 said they were in the form of caps on funding or the number of rheumatoid arthritis patients allowed the treatment, 12 reported limits on staffing to meet patient needs, and 4 reported lack of other facilities. Forty-eight respondents also reported a waiting list for such therapies, according to researchers.

Ninety respondents said they are able to prescribe anti-tumor necrosis factor agents for ankylosing spondylitis or psoriatic arthritis in at least some circumstances, leaving 33% of consultant rheumatologists unable to prescribe the therapies for those patients, the researchers wrote.

“The fact that different funding organizations set different restrictions has led to variation of access for equally affected patients to effective treatment, depending on where they live,” the authors said. “Long waiting times for patients to receive these drugs once a decision to prescribe has been made are not uncommon, which will add further to their deterioration and compromise their likely outcome.”

The organization representing NHS trusts would not comment directly on the survey, but did defend the decisions of its members. “[Primary care trusts] receive a fixed allocation of money to deliver all the services for their local community and have to take difficult decisions on competing priorities,” Nigel Edwards, director of policy at the NHS Confederation, said in a written statement.

“For example, this year many PCTs have been faced with decisions about spending money on expensive drugs and cutting waiting lists.

“The decisions that PCTs take are informed by professional executive committees made up of doctors and nurses, as well as managers,” Mr. Edwards said. “These committees decide what the local priorities are, and, as every community is different, it is not surprising that they often reach different decisions.

“Many primary care trusts also have active ways of engaging their communities in the decisions they make, and naturally, communities will have different views and priorities themselves.”