MS Disease-Modifying Therapy Gains Come at High Cost in U.S.
Cost-effectiveness of all disease-modifying drugs more than $800,000 per quality-adjusted life year
WEDNESDAY, July 20 (HealthDay News) -- Disease-modifying therapies (DMTs) are not cost-effective for treating patients with multiple sclerosis (MS) in the United States compared to basic supportive therapy without DMTs, according to a study published online July 20 in Neurology.
Katia Noyes, Ph.D., M.P.H., from the University of Rochester in New York, and colleagues compared the cost-effectiveness of DMTs and basic supportive therapy without DMTs for 844 patients with relapsing MS in the United States. Ten-year disease progression paths were generated using data from a longitudinal MS survey, and transitional probabilities were estimated using first-order annual Markov models. Medical costs were estimated, and costs associated with loss of employment were obtained from the Bureau of Labor Statistics. The outcomes were evaluated as gains in quality-adjusted life-years (QALY) and relapse-free years. Model uncertainty was evaluated by Monte Carlo simulations, resampling methods, and sensitivity analyses.
The investigators found that 10-year DMT use for all DMTs was associated with modest health gains compared to treatment without DMT (0.082 QALY or <1 quality-adjusted month gain for glatiramer acetate, and 0.126 to 0.192 QALY gain for interferons). Cost-effectiveness for all DMTs was much higher than $800,000 per QALY. The greatest impact on making these treatments more cost-effective was reducing the overall cost of DMTs. Initiating DMT treatment earlier was associated with a lower and more favorable cost-effectiveness ratio compared to initiating treatment at any disease state.
"Use of DMT in MS results in health gains that come at a very high cost," the authors write.
Several of the study authors disclosed financial ties to the pharmaceutical industry.