Thursday, 7 May 2015

Cost of treatment set to Soar

Hartung DM, Bourdette DN, Ahmed SM, Whitham RH The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail? Neurology. 2015 Apr. pii: 10.1212/WNL.0000000000001608. [Epub ahead of print]

OBJECTIVE:To examine the pricing trajectories in the United States of disease-modifying therapies (DMT) for multiple sclerosis (MS) over the last 20 years and assess the influences on rising prices.
METHODS: We estimated the trend in annual drug costs for 9 DMTs using published drug pricing data from 1993 to 2013. We compared changes in DMT costs to general and prescription drug inflation during the same period. We also compared the cost trajectories for first-generation MS DMTs interferon (IFN)-β-1b, IFN-β-1a IM, and glatiramer acetate with contemporaneously approved biologic tumor necrosis factor (TNF) inhibitors.
RESULTS: First-generation DMTs, originally costing $8,000 to $11,000, now cost about $60,000 per year. Costs for these agents have increased annually at rates 5 to 7 times higher than prescription drug inflation. Newer DMTs commonly entered the market with a cost 25%-60% higher than existing DMTs. Significant increases in the cost trajectory of the first-generation DMTs occurred following the Food and Drug Administration approvals of IFN-β-1a SC (2002) and natalizumab (reintroduced 2006) and remained high following introduction of fingolimod (2010). Similar changes did not occur with TNF inhibitor biologics during these time intervals. DMT costs in the United States currently are 2 to 3 times higher than in other comparable countries.
CONCLUSIONS: MS DMT costs have accelerated at rates well beyond inflation and substantially above rates observed for drugs in a similar biologic class. There is an urgent need for clinicians, payers, and manufacturers in the United States to confront the soaring costs of DMTs.

The MS Market is currently about $20 billion and rising, Having realised that people with MS would pay a lot for drugs that were not very effective, with increasingly active drugs the cost soars ever higher.  In the USA it means increasing insurance costs and in the UK it means NICE first delay access to drugs as they haggle down the cost and probably NHS rationing will start as trusts seek to limit prescribing of drugs that will ultimately bankrupt them. The Risk Sharing Scheme results have allowed companies to hike their price.

The solution will have to wait until patents expire and chemicals arrive, but companies will do their utmost to ensure that they don't do that in a hurry. 

Alternatively we could develop a generic (or could we?) if there was a will and a pathway to do it.  Surprisingly there seems to be neither.

What happens when we have neuroprotective and remyelinating drugs what will the costs be then? Who will get there first academia or pharma...I know where my money is placed.

28 comments:

  1. "The solution will have to wait until "patients"[sic] expire and chemicals arrive. Alternatively we could develop a generic if there was a will and a pathway to do it." MD2, this reminds me of the Nick Lowe song lyric "and so it goes, and so it goes, where it's going no one knows." As the authors state: "we need to confront the soaring cost of the DMTs" and so it goes...........

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    1. Hi Steve
      Another Nick Lowe comes to mind, we need to be "Cruel to be kind" regarding the urgent need to reduce the in many cases outrageous costs of drugs for MS. I think there was a case going through the US courts regarding diabetes drugs, let's hope they move onto MS asap.

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    2. Who's Nick Lowe and what's he got to do with MS?

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    3. "What's so funny 'bout peace, love & understanding?" ;-)
      https://www.youtube.com/watch?v=lAqAmLSIGU8

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    4. Re: who is Nick Lowe, great singer/song writer and producer, check it out. Nothing to do with MS but who needs an excuse to listen:-) He wrote "what's so funny about peace, love and understanding" best known from Elvis Costello.

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  2. Vote or die, people of Britain!

    The Tories will kill the NHS if you don't vote them out by the end of play today.

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    1. Dead Already. Only it doesn't know it yet

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    2. I feel you're right, Anon 2:02pm.

      For all the harking on about DMTs this blog does, chances are we sufferers will be out priced if they ever come to bloom.

      Still, I want the Conservatives gone. The bedroom tax has hit me hard.

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    3. The NHS is unsustainable. There'll always be a crappy service funded for poor people, but honestly reckon we're going to move to an American system of healthcare.

      New Labour and the Tory-led Coalition have killed British values. Long live the SNP!

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    4. The NHS is not unsustainable, it needs to be prioritised. The American system of healthcare costs 3 times as much as ours (at least) and the most vulnerable cannot access it. Is that what you really want, as most measures show our system is better? Stick with the party that brought it into being.

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  3. It will be so sad if we end up with a Tory government again. They have been horrid.

    Labour have stage managed their whole campaign and look unworthy for government.

    SNP are a party Scotland needs. We need to get back to true socialism. Júst imagine: Nicola Sturgeon, Leanne Wood and Natalie Benet could be in front cabinet tomorrow in hung parliament. That's right, three women with intelligence and kindness. iT would be fantastic.

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    1. And the country will be split up. It's a shame they want to spend money the country hasn't got. What would Nicola do without the Barnett formula? Be wary of what you wish for. All my Tory leaflets hardly mention the NHS what does that say? There's only one way to save the NHS and it's not bankrupting the country. It's such a shame politicians have caused divisions in the United Kingdom which I'm afraid will never be the same.

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  4. I have MS and vote Conservative. The NHS can go to hell if it prevents me from accessing DMTs I can afford. Why should I be denied them just because the NHS can't fund it for everyone.

    On the week we in Britain have had a new Royal princess to be proud of, this is not the time for socialist peasants to feel sorry for themselves because they didn't work hard at school and have no ambitions.

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    1. And this post is evidence of just why we "love" the Tories.
      Peasant (and proud of it).

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    2. This has to be a wind up. I can't believe what this person as just said. How cruel and selfish.

      This is so typically Tory. I worked hard in life but haven't become a millionaire. I ought not be made ashamed of that.

      I hate where Britain seems to be heading.

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    3. Oh boy, I'm speechless at Tory Boy's comment.

      How dare you call ordinary MSers peasants. I'm off straight to my polling station now to vote Labour.

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    4. I wonder what organisation trained the neurologists and doctors that helped bring the introduction of treatments for MS? Lovely, there's an awful lot of well educated peasants out there that became doctors and scientists from hard graft and a will to help people.

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    5. Your party deserves to lose for that comment.

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    6. I would be so happy for you to be infused with Tysabri at the earliest opportunity .

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  5. When I first was diagnosed with MS I was shocked at how much these drugs cost. Talking to other long time MSers the first line injectable inital cost when they were released was about $4k/yr. Know these same drugs cost $40k/yr.

    I don't understand why these drugs cost so much. It seems like their initial set cost should have set the price allowing for increases due to inflation. But it looks like Pharma is raising the price to test what can be gotten out of insurance companies.

    Personally I think that the MS market needs some sort of price controls put in place.

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    1. It is based on what you will pay. The price for the same drug would be priced for different conditions at different prices and would be priced differently when used for pets

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  6. Anon 4:47 - Aren't the royals wards of the state? It seems odd that you would condemn 'socialist peasants' in one breath, and then take pride in the luckiest welfare recipients in the country with the next.

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  7. The NHS is so fundamental to MSers. I get up every morning and one of my gratitudes is the NHS. Although one shouldn't feed the trolls the above Tory anon is why we cannot leave the NHS in Tory hands. It's not too late to vote for change if you haven't done already. As for the self centred attitude of unless I get the the expensive drugs I need then no one gets the NHS is possibly the most cause for concern about your post.

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  8. At the risk of feeding the Tory troll. The NHS is not perfect but it is wonderful. I hope anyone who has not voted yet decides to choose to protect the NHS and it is not safe in Tory hands

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  9. Exit poll suggest that Tories have won the majority of votes. Dang!

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  10. To put some political balance back in this blog- rejoce, rejoice as Mrs T said. The people have spoken. Just because i have MS doesn't mean I have to support a left wing party who left is with crippling debt.

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    1. I'm surprised you're back after you're previous unpleasant post.
      As Neil Kinnock put it;
      "I warn you not to be ordinary
      I warn you not to be young
      I warn you not to fall ill
      I warn you not to get old."

      This is the 92 election all over again and those of us old enough remember what a "success" that was. The parallels are striking.

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    2. I do not have any allegiance to any party. I've had MS for a long time and worked extremely hard full time for over 30 years. I was working in the ''80s when then unemployed were moved to incapacity benefit. I knew people that did this, but it didn't persuade me to live on benefits. I have been an inpatient when the Thatcher government were in power. The wards were not cleaned and doctors and nurses were almost on their knees trying to care for us. I have had serious illnesses since the Blair years through no fault of my own, I don't smoke or drink, ate healthily and exercised at least three times a week. The care I received after 8 years of Labour's investment saved my life., The SPMS is now ruling my life and no matter how much of my salary I saved to prepare not to burden the state, being disabled is expensive. I vote from experience , not because I'm a socialist peasant.

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