Friday, 18 November 2016

The cost of treating MS

Bozkaya D, Livingston T, Migliaccio-Walle K, Odom T.The cost-effectiveness of disease-modifying therapies for the treatment of relapsing-remitting multiple sclerosis. J Med Econ. 2016 Nov 8:1-16. [Epub ahead of print]

BACKGROUND:The safety and efficacy of disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) has been established; however, it is not clear which provides optimal value, given benefit-risk profiles and costs.
AIMS:To compare the cost-effectiveness of current DMTs for patients with RRMS in the United States (US).
MATERIALS AND METHODS: A model predicting RRMS course following initiation of a DMT was created comparing outcomes (e.g., relapses, disease progression) and costs of natalizumab (NTZ), dimethyl fumarate (DMF), and peginterferon beta-1a (PEG) with fingolimod (FIN), glatiramer acetate (GA, 20 mg daily), and subcutaneous interferon beta-1a (IFN, 44 mcg), respectively, over 10 years. RRMS and secondary-progressive MS (SPMS) EDSS state transitions were predicted in 3-month cycles in which patients were at risk of death, relapse, or discontinuation. Upon DMT discontinuation, natural history progression and relapse rates were applied. Incremental cost-effectiveness ratios (ICERs) were estimated for the cost per relapse avoided, relapse-free years gained, progression avoided, and progression-free years gained. The impact of model parameters on outcomes was evaluated via one-way sensitivity analyses.
RESULTS: Costs ranged from $561,177 (NTZ) to $616,251 (GA). NTZ, DMF, and PEG were dominant (less costly and more effective) compared to FIN, GA, and IFN, respectively, for all ICERs. Variability in drug costs and parameters that affected drug cost accrual (e.g., discontinuation rates and the decision to drop out after SPMS conversion) had a considerable impact on ICERs.
LIMITATIONS: Several simplifying assumptions were made that may represent potential limitations of this analysis (e.g., a constant treatment effect over time was assumed).
CONCLUSIONS: The results from this analysis suggest that the NTZ, DMF, and PEG are cost-effective DMT choices compared to FIN, GA, and IFN, respectively. The actual impact on a particular plan will vary based on drug pricing and other factors affecting drug cost accrual.

I am not going to try to pull this study apart but I guess the makers of  FIN, GA and IFN may have something to say, but over half a million dollars over ten years.

How is someone in a resource poor country ever going to afford this?  Is this why DMT get rationed in socialised medicine settings


3 comments:

  1. Hmm…
    NTZ, DMF and PEG all Biogen products…
    Two of the authors Biogen employees…
    Just an observation…

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    Replies
    1. Expect we,ll see a Roche one soon saying ocrelizumab is more effect....oh I forgot that's part biogen too. Actually it seems that many drugs are co owned by one of the other companies maybe this is why it seems like a cartel.

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  2. Why are GA and IFN so expensive? They are injectables (people don't like injectables) and not very effective.

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