Wednesday, 11 January 2012

Research: The Cost of A Relapse

Oleen-Burkey et al. Burden of a Multiple Sclerosis Relapse: The Patient's Perspective.Patient. 2012 Jan. doi: 10.2165/11592160-000000000-00000. [Epub ahead of print]

Background: Relapses are a common feature of relapsing-remitting multiple sclerosis (RRMS) and increasing severity has been shown to be associated with higher healthcare costs, and to result in transient increases in disability. Increasing disability likely impacts work and leisure productivity, and lowers quality of life.

Objective: The objective of this study was to characterize from the patient's perspective the impact of a multiple sclerosis (MS) relapse in terms of the economic cost, work and leisure productivity, functional ability, and health-related quality of life (HR-QOL), for a sample of patients with RRMS in the US treated with immunomodulatory agents.

Methods: A web-based, self-report survey was conducted among members of MSWatch.com, a patient support website now known as Copaxone.com. Qualified respondents in the US had been diagnosed with RRMS and were using an immunomodulatory agent. The survey captured costs of RRMS with questions about healthcare resource utilization, use of community services, and purchased alterations and assistive items related to MS.

Results: Of 711 qualified respondents, 67% reported having at least one relapse during the last year, with a mean of 2.2 ± 2.3 relapses/year. Respondents who experienced at least one relapse had significantly higher mean annual direct and indirect costs compared with those who did not experience a relapse ($US38,458 vs $US28,669; p = 0.0004) [year 2009 values].

Direct health-related costs accounted for the majority of the increased cost ($US5,201; 53%) and were mainly due to increases in hospitalizations, medications, and ambulatory care.

Indirect costs, including informal care and productivity loss, accounted for the additional 47% of increased cost ($US4,588). Accounting for the mean number of relapses associated with these increased costs, the total economic cost of one relapse episode could be estimated at about $US4,449, exclusive of intangible costs.

The mean self-reported Expanded Disability Status Scale (EDSS) score, derived from the Goodin MS questionnaire, was significantly higher with relapse than with a clinically stable state (EDSS 4.3 vs 3.7; p < 0.0001), while the mean health utility score was significantly lower with relapse compared with a clinically stable state (0.66 vs 0.75; p = 0.0001). The value of these intangible costs of relapse can be estimated at $US5,400.

The overall burden (direct, indirect, and intangible costs) of one relapse in patients treated with immunomodulatory agents is therefore estimated conservatively at $US9,849.

Conclusions: This study shows that from a patient's perspective an MS relapse is associated with a significant increase in the economic costs as well as a decline in Health Related Quality of Life ratings and functional ability.

Costs of MS
Sánchez-de la Rosa R, Sabater E, Casado M, Arroyo R. Cost-effectiveness Analysis of Disease Modifiying Drugs (Interferons and Glatiramer Acetate) as first line treatments in Remitting-Relapsing Multiple Sclerosis patients.J Med Econ. 2012 Jan [Epub ahead of print]

Objective:
The aim of this study was to assess cost-effectiveness of the different Disease Modifying Drugs (DMD) used as first-line treatments (interferons IM IFNβ-1a, SC IFNβ-1a, SC IFNβ-1b and glatiramer acetate, GA) in Remitting-Relapsing Multiple Sclerosis (RRMS) in Spain.

Methods: A Markov model was developed to simulate the progression of a cohort of patients with RRMS, during a period of 10 years. Seven health states, defined by the Expanded Disability Status Scale (EDSS), were considered in the model. Patients with an EDSS score of less than 6.0 were assumed to be treated with one of DMD. In addition, all patients were assumed to receive symptomatic treatment. The monthly transition probabilities of the model were obtained from the literature. The analysis was performed from the societal perspective, in which both direct and indirect (losses in productivity) healthcare costs (€, 2010) were included. A discount rate of 3% was applied to both costs and efficacy results.

Results: The estimated costs were about €323,000-€ 348,000.


Although the figures will difffer between the UK it further highlights just some of the costs associated with MS. But there are many others that need to be accounted for when assessing the real cost-benefit analysis of expensive drugs that treat relapses. Whilst the report shows that some agents have a more favourable cost-benefit analysis, this is relative as in my humble opinion, they all cost too much!

2 comments:

  1. They all cost too much and ProfG thinks they should cost more because the US is subsidising the rest of the world

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  2. Re: "They all cost too much and ProfG thinks they should cost more because the US is subsidising the rest of the world."

    I also think they cost too much, but particularly in the US. I don't think that US MS'ers should be paying so much more for drugs than the rest of the world. At some stage this may lead to a conflict between socialist and private healthcare systems. This may lead to a trade war, which is not in the interests of MS'ers the world over.

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