title: Access to tumour necrosis factor inhibitors for rheumatoid arthritis treatment under the Australian Pharmaceutical Benefits Scheme: are we on target?
abstract: BACKGROUND
  Access to tumour necrosis factor inhibitors (TNFI) for the treatment of rheumatoid arthritis under the Australian Pharmaceutical Benefits Scheme (PBS) is governed by a set of arrangements, operational from August 2003. Patients must meet strict criteria for both starting and continuing TNFI. Examination of utilization data is important for assessing the broader implications of arrangements for access to expensive pharmaceuticals under schemes such as the PBS.
  
  
  OBJECTIVE
  To examine the uptake of TNFI over the first year of subsidized availability of etanercept under the PBS, and to compare these data to the predicted utilization and expenditure.
  
  
  METHODS
  Collection and analysis of prescription and expenditure data for the three listed TNFI: etanercept, infliximab and adalimumab processed under the PBS for the period August 2003 to July 2004.
  
  
  RESULTS
  A total of 8,053 prescriptions for TNFI was reimbursed at a total cost of 15.2 m Australian dollars. The total PBS expenditure on etanercept was just over 14 m Australian dollars, 14% of the predicted annual expenditure. The relative per capita uptake of etanercept was highest in the Australian Capital Territory and lowest in the Northern Territory. More than 50% of prescriptions for etanercept were for concessional patients (7.3 m Australian dollars).
  
  
  CONCLUSIONS
  Prescription rates and expenditure on etanercept were substantially below those forecast over the first year. There are opportunities to adjust the PBS restrictions for subsidized access to TNFI to benefit more patients.
authors.affiliation: School of Medical Sciences, University of New South Wales, NSW, Australia. christine.lu@student.unsw.edu.au
authors.forename: C Y
authors.initials: CY
authors.lastname: Lu
authors.forename: K M
authors.initials: KM
authors.lastname: Williams
authors.forename: R O
authors.initials: RO
authors.lastname: Day
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D001315:Australia; D004363:Drug Utilization / Q000191:economics; D000068800:Etanercept; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000191:economics / Q000627:therapeutic use*; D000069285:Infliximab; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000191:economics; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept