Did you start DMTs before you became disabled or afterwards? #ClinicSpeak #BrainHealth #MSBlog #MSResearch
"The study below tries to the, near impossible, task of predicting the 10-yer cost of treating MS. It is clear that increasing disability is associated with higher costs and this confirms what we know from previous studies. Despite the strong link between disability and cost, some neurologists still warehouse their patients waiting for them to develop disability before referring them for a DMT assessment. At a lesser level this happens with highly effective therapies as well. I was asked an opinion about a young woman with newly diagnosed MS who had had two disabling relapses in the last 8 months (optic neuritis and ataxia) and made a good recovery from the attacks as was fully functional. Her MRI has a moderate lesion load with posterior fossa lesions and two Gd-enhancing lesions. When I suggested to her neurologist that in addition to the platform therapies he should also offer her the option of being treated with either alemtuzumab or natalizumab. He was shocked and said: 'But isn't that being a bit aggressive, she doesn't have any disability yet'. I had to remind him that she fulfilled NHS England criteria for both alemtuzumab and natalizumab. It is clear that our 'Brain Health: Time is Brain' message is not appreciated by all neurologists. The use of DMTs as a preventive therapy, i.e. to prevent future disability and to maximise lifelong brain health, has not sunk in yet."
"You will see below that the treatment of MS if you are female costs less than if you are a male. I suspect this relates to the poorer prognosis, i.e. more disability, seen in males with MS."
Moccia et al. Predictors of the 10-year direct costs for treating multiple sclerosis. Acta Neurol Scand. 2016 Jun 29.
OBJECTIVES: Disease-modifying treatments (DMTs) constitute the largest direct medical cost for multiple sclerosis (MS). This study aims at investigating predictors of the 10-year economic burden for DMT administration and management.
MATERIALS AND METHODS: This study included 537 newly diagnosed, drug naïve relapsing-remitting MS (RRMS) patients, followed up for 10.1±3.3 years. Costs for DMT administration and management were calculated, and referred to each year of observation (annual costs). Possible predictors of disease evolution were categorized into early predictors (age, gender, disease duration, baseline expanded disability status scale (EDSS), 1-point EDSS progression within 2 years, and annualized relapse rate -ARR- within 2 years), and long-term predictors (reaching of EDSS 4.0, conversion to secondary progressive -SP-, ARR, number of DMTs, follow-up duration). Association between predictors and study outcome was explored using mixed-effects log-linear regression models.
RESULTS: A 1-point higher EDSS at diagnosis was associated with 13.21% increase in the annual costs (95%CI=4.16-23.04%). Each additional year of age at diagnosis was associated with a 0.74% decrease in the annual costs (95%CI=-1.43 to-0.04%). Female gender was associated with a 12.43% decrease in the annual costs (95%CI=-22.61 to-0.93%). Converting to SP was associated with a 14.26% decrease in the annual costs (95%CI=-14.26 to-2.94%). Each additional year of follow-up was associated with a 3.05% decrease in the annual costs (95%CI=-4.51 to-1.57%).
CONCLUSIONS: An estimate of the 10-year costs associated with DMT administration and management can be calculated by analyzing different factors, and might be of particular interest for planning resources needed for treating people with MS.