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Editor's Correspondence |

Etanercept or Infliximab: The Patient's Considerations

Robert C. Sherrick, MD
Arch Intern Med. 2006;166(13):1418. doi:10.1001/archinte.166.13.1418-a.
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The article by Morgan Dewitt et al1 concerning the effect of insurance coverage on the choice between etanercept and infliximab is an important addition to the effect of public policy on the delivery of medical care. I believe, however, that the authors have overemphasized the influence of the prescribing physician and have not taken into account modern practices of shared decision making with patients.

When faced with 2 medications with similar effectiveness but very different costs and administration, most physicians would present both medications as therapeutic options and, after informing the patient of the advantages and disadvantages of each medication, would proceed to work toward a shared decision between the 2 options, taking into account the patient's pREFERENCES. In this particular case, the financial incentive for the patient is often much larger than it is for the prescribing physician; a Medicare patient with no other drug coverage (before the advent of Medicare part D) would have to pay the entire amount for etanercept, but only a copayment for infliximab. Given the high cost of these medications, my experience is that without insurance coverage, etanercept is not a financial possibility for any but the wealthiest patients, and even the Medicare copayments are often a deterrent to the use of infliximab. Patients usually have a strong preference between the 2 choices, most often seemingly based overwhelmingly on their cost. The choice of which medication to prescribe is rarely one I make; rather, the patient is most commonly the primary decision maker.

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