PND26 Estimated Costs of First-Year Monitoring and Administration of Multiple Sclerosis Therapies in the United States

Abstract

inpatient care and drug costs represented about 50% and 27% respectively of overall expenses. The increase by 24.4% polytherapy patients mean costs as compared to monotherapy raised to 72% [IC 95: 44-106%] after adjustment on age, gender and presence of severe comorbidity. CONCLUSIONS: Polytherapy in epilepsy is associated with substantial higher direct costs. OBJECTIVES:To develop a tool to estimate the first-year per member and total health plan costs associated with monitoring of MS therapies in the United States. METHODS: Data were incorporated into an interactive tool designed to allow a health plan to estimate their costs for monitoring. MS prevalence was based on the literature. The default value for the proportion of MS patients treated with immunomodulators was assumed at 95% and adjusted IMS data were used for default market share inputs. Current Procedural Terminology (CPT) codes corresponding to the monitoring and administration procedures recommended by each product's prescribing information (PI) were identified. Charges associated with each CPT code were assigned using physician fee schedule software based on Medicare charges with default values set at 150%. PI recommendations were used for the proportion being monitored and the frequency of monitoring. In cases where a PI recommended only individuals with specific characteristics undergo monitoring, a database analysis identifying all individuals with a diagnosis of MS in the i3 InVision Data Mart (Ingenix, Eden Prairie, MN) was used to estimate the proportion of patients who may require that specific monitoring. RESULTS: The tool yielded average per patient and health plan costs expected with MS therapy monitoring. The tool conservatively estimates that the average per member first-year monitoring and administration costs ranged from $0 for glatiramer acetate to $3279 for natalizumab. Based on default values, the estimated annual costs of monitoring for all MS therapies for a million member health plan is $519,451. CONCLUSIONS: Estimating the economic impact of FDA-recommended MS therapy monitoring allows health plans to more closely assess the total cost of MS. This tool allows health plans to individualize inputs to estimate the plan-specific economic impact of MS therapy monitoring.