Cost of disease modifying therapies for multiple sclerosis: Is front-loading the answer?

Abstract

There are now over a dozen disease modifying therapies (DMTs) available to treat multiple sclerosis (MS). They vary in efficacy and safety as well as in cost.The literature on the cost effectiveness of these is often confusing and contradictory. There is a lack of quality evidence enabling the comparison of different DMTs. There are scarce randomised controlled trials which look at one DMT compared with another that is not IFN or GA. There is also a lack of systematic reviews comparing the efficacy and safety of different DMTs. This makes it difficult to perform good quality cost-effectiveness analyses (CEAs). Furthermore, CEAs in and of themselves are difficult to interpret or compare due to the variation in methods and cost estimations as well as the use of outcome measures which cannot be proven over a reasonable timeframe.This review looks at the different DMTs available for MS and attempts to draw some conclusions on their cost-effectiveness. It also considers the costs and benefits of front loading the cost of treatment for MS by using more expensive and effective treatment earlier on.

Early and unrestricted access to high-efficacy disease-modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis

“…The long-term cost-effectiveness of early versus late use of HE DMTs has been studied in numerous analyses, most of which confirm the positive socio-economic impact of early use of HE DMTs [ 41 ]. It is suggested that initial investment in the early use of HE DMTs may reduce overall costs in the long-term by reducing disability progression [ 41 ].…”

“…The long-term cost-effectiveness of early versus late use of HE DMTs has been studied in numerous analyses, most of which confirm the positive socio-economic impact of early use of HE DMTs [ 41 ]. It is suggested that initial investment in the early use of HE DMTs may reduce overall costs in the long-term by reducing disability progression [ 41 ]. However, such long-term benefits and savings might be at odds with payers’ short-term budget needs, and, additionally, overall societal costs may be beyond canonical payers’ remit.…”

Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients

“…DMD costs account for most of the direct healthcare costs in MS. They have rapidly risen in the past few years and are expected to further increase among overall expenses, to the point where some studies estimate them to be beyond the health care system tolerance or the generally accepted cost-effectiveness thresholds [ 6 , 7 ]. Some DMDs have been proven highly efficacious, at the expense of potential life-threatening side effects, e.g.…”

“…Some DMDs have been proven highly efficacious, at the expense of potential life-threatening side effects, e.g. progressive multifocal leukoencephalopathy (PML) for natalizumab, the important lymphopenia for cladribine, ocular disorders for fingolimod, and the increased risk of pulmonary hemorrhages, heart attacks, strokes and cervical-cephalic arterial dissection for alemtuzumab [ 2 , 7 ]. DMD treatment reduces the number of relapses and progression of disability in the short term, and an emerging corpus of data suggests that the onset of a secondary progressive phase can also be delayed [ 8 , 9 ].…”

“…Ablation of the immune system followed by autologous hematopoietic stem cell transplantation (AHSCT) for the treatment of MS has been explored for approximately two decades since the original pivotal report of its feasibility [ 12 ]. AHSCT is a once-only treatment whose therapeutic effect could last for many years; thus it might represent a cost-saving opportunity compared with continuous treatment with DMDs [ 7 , 13 ].…”