The cost of multiple sclerosis drugs in the US and the pharmaceutical industry

Too big to fail?

Daniel M. Hartung, PharmD, MPH, Dennis N. Bourdette, MD, Sharia M. Ahmed, MPH, and Ruth H. Whitham, MD

Abstract

 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.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451044/

A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis

Ashley N. Newton, MHA, MAcc, CPA and Christina M. Stica, MHA

Abstract

The purpose of this study was to examine the cost-effectiveness of four disease-modifying drugs (DMDs) used to treat multiple sclerosis (MS): glatiramer acetate (GA; Copaxone), interferon beta-1a (IFNβ-1a) intramuscular (IM) injection (Avonex), IFNβ-1a subcutaneous (SC) injection (Rebif), and interferon beta-1b (IFNβ-1b) SC injection (Betaseron). Cost-effectiveness analyses are useful in countering the financial uncertainties and treatment efficacy concerns faced by people with MS. We conducted simulation analyses of the principal findings of a 2009 study by Goldberg et al. (Goldberg LD, Edwards NC, Fincher C, et al: Comparing the cost-effectiveness of disease-modifying drugs for the first-line treatment of relapsing remitting multiple sclerosis. J Manag Care Pharm. 2009;15:543–555) to frame the researchers' findings from the perspectives of cost-conscious and cost-neutral MS patients. We found that for the cost-conscious consumer, the ranking of most (1) to least (4) preferred DMDs was 1) IFNβ -1a IM (Avonex), 2) GA (Copaxone), 3) IFNβ-1a SC (Rebif), and 4) IFNβ-1b SC (Beta-seron). For the cost-neutral consumer who places priority on effectiveness over costs, the ranking was 1) IFNβ-1a SC (Rebif), 2) IFNβ-1b SC (Betaseron), 3) GA (Copaxone), and 4) IFNβ-1a IM (Avonex). Future studies could examine cost-effectiveness over extended periods of time (eg, 15–20 years) and more closely examine the cost-effectiveness of natalizumab (Tysabri) relative to the four primary DMDs.

The cost of health care in the United States is escalating rapidly, placing continual strain on the US economy and causing the number of people without health insurance to increase. Thus, it is essential to examine every aspect of the current health-care system to identify solutions and reduce costs. Although technological improvements tend to enhance health-care outcomes, they have also led to higher expenses.

Cost-effectiveness analyses are used to assess the monetary cost of disease-modifying drugs (DMDs) relative to their effectiveness in achieving a predefined purpose. According to the Centers for Disease Control and Prevention (CDC), a cost-effectiveness analysis represents “a type of economic evaluation that examines both the costs and health outcomes of alternative intervention strategies . . . [by comparing] the cost of an intervention to its effectiveness as measured in natural health outcomes.”1 For people with multiple sclerosis (MS), examples of relevant costs are the cost of medication, office visits, and hospital stays; examples of relevant health outcomes are the avoidance of complications such as relapses, physical disability, fatigue, and depression. To counter the financial uncertainty and concerns of MS patients, medical professionals should be knowledgeable about the cost-effectiveness of those disease-management therapies for which costs and health outcomes are readily quantifiable.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882969/

Soya lecithin induced multiple sclerosis model will be best suits.

Drug treatment of multiple sclerosis

Chris H Polman, Professor1 and B M J Uitdehaag, Neurologist1

Multiple sclerosis is the most common cause of chronic neurologic disability in young adults, with a prevalence of about 1 in 1,000. About 50% of patients are unable to walk without assistance 15 years after onset. As yet, no treatment can halt the accumulation of disability. In recent years, however, there has been substantial progress in understanding the pathogenetic mechanisms of the disease and in developing techniques to monitor treatment. Based on this progress, treatments were developed that have a favorable effect on the natural course of the disease (disease-modifying drugs). We discuss the evidence available from large randomized, placebo-controlled studies, and we address several questions that still generate wide interest in relation to treatment with disease-modifying drugs. The treatment of symptoms and rehabilitation, which still remain the mainstay of care of most patients with multiple sclerosis, are not reviewed here. here.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071194/

Thank you for the valuable suggestions