The Washington Post

Are MS drugs cost-effective?

A new analysis of disease-modifying therapies (DMT) for treating multiple sclerosis finds that those drugs provide only modest benefits at great expense — at least in the United States.

The study, published Wednesday afternoon in the journal Neurology, weighs the costs and benefits of drugs the FDA has approved for treating MS, an autoimmune disease in which immune-system cells attack the protective sheath that covers nerves in the central nervous system, causing a wide array of symptoms. Looking at the impact of therapy on the course of the disease over 10 years, the researchers found that, in short, MS drugs cost too much for the job they do.

In other developed nations, the study notes, MS drugs cost less than they do in the United States, so their cost-effectiveness in those places is boosted, even though their effectiveness remains the same.

The study found small gains in a measure called “quality-adjusted life years” (QALY) and in gains in relapse-free years among users of any of four DMTs as compared to those who were managing their MS without such drugs. But those small gains came at great expense: The cost per QALY was calculated to be $800,000. That’s far higher an amount than is typically considered cost-effective; lowering it by 67 percent, the study suggests, would bring the cost into line with the cost of DMT in other nations and render DMT acceptably cost-effective.

Another key finding: The study determined that MS drugs are more cost-effective when started early. That’s important, says Nicholas LaRocca, vice president of healthcare delivery and policy research at the National MS Society (which helped fund the study), because many patients decline drug therapy when they are first diagnosed with MS, often taking a wait-and-see approach.

LaRocca says the new research points to the need to “look for therapies that are even more effective” than those currently available, whose efficacy can vary greatly from patient to patient.

MS users who feel their drug therapies have benefited them substantially, even saved their lives, may get their backs up over this issue of cost-effectiveness. Who cares if a drug we need ourselves is “cost-effective” on a population-wide basis? As LaRocca notes, “It’s very difficult to translate cost-effectiveness findings into an individual case.”

Still, none of us would argue that our drugs aren’t expensive enough; even with generous insurance coverage (which covers most of the $52,000 my particular DMT would cost without insurance) and assistance from a patient-support program, my daily injection costs me just under $100 a month.

I pay that happily and with gratitude for the fact that, knock on wood, my MS hasn’t progressed in the 10 years since I was diagnosed. (I started my injections within weeks of being diagnosed.) And I sure would be upset if my insurance company used this study to determine my drug wasn’t cost-effective enough to keep covering it for me.

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