Updated cost-of-care estimates for commercially insured patients with multiple sclerosis: retrospective observational analysis of medical and pharmacy claims data

Abstract

BackgroundFor patients with multiple sclerosis (MS), previous research identified key disease sequelae as important cost drivers and suggested that among users of disease-modifying drugs (DMDs) in 2004, DMDs represented 73% of the total cost of care. More recent studies were limited to incident disease/treatment and/or excluded DMDs from cost estimates. To support contemporary pharmacoeconomic analyses, the present study was conducted to provide updated information about MS-related costs and cost drivers including DMDs.MethodsFor each of 2 years, 2006 and 2011, commercially insured, continuously eligible patients with ≥ 1 medical claim diagnosis of MS were sampled. MS-related charges were based on medical claims with MS diagnosis plus medical/pharmacy claims for DMDs. 2006 charges were adjusted to 2011 $ using the medical care component of the consumer price index (CPI). Subgroups of patients using DMDs (interferon [IFN] beta-1a intramuscular or subcutaneous, IFN beta-1b, glatiramer, natalizumab) in 2011 were identified. By-group differences were tested with bivariate statistics.ResultsMean (standard deviation [SD]) age of 15,902 sample patients in 2011 was 47.6 (11.8) years, 76% female. Mean [SD] MS charges ($26,520 [$38,478] overall) were significantly (P < 0.001) higher for patients with common disease sequelae: malaise/fatigue (n = 2,235; $39,948 [$48,435]), paresthesia (n = 1,566; $33,648 [$45,273]), depression (n = 1,255; $42,831 [$51,693]), and abnormality of gait (n = 1,196; $48,361 [$55,472]). From 2006 to 2011, CPI-adjusted MS charges increased by 60%. Among patients treated with a single DMD in 2011, inpatient care was 6% of charges (range = 4%-8%; P = 0.155); outpatient care was 19% (range = 14%-20% except for natalizumab [29%]; P < 0.001); and DMDs were 75% (range = 67%-81%; P < 0.001).ConclusionsCommon MS sequelae remain important cost drivers. Although MS treatment costs are increasing, the proportion of MS charges due to DMDs in 2011 is similar to that reported in 2004.

Multiple Sclerosis and the Comparative Value Disease Modifying Therapy Report of the Institute for Clinical and Economic Review (ICER)

“…Four of the DMTs had annualized cost increases above 20% and four with annualized price increases between 13.0% and 16.8%. Natalizumab, for example, although being withdrawn briefly from the market between 34 . At the same time, the charge increase for DMTs far outstripped the charges for other medical services (95.7% vs. 32.4%).…”

Stopping immunomodulatory medications in MS: Frequency, reasons and consequences

“…19 Despite approval of 12 agents by the FDA for treatment of relapsing remitting MS, the cost of disease modifying treatments has continued to rise 49 and the proportional cost of DMTs relative to total cost of care has not changed from 2004 to 2011. 19 As the frequency of MS relapses reduces with advancing age, 18 the cost-benefit ratio rises over the life of the patient.…”

“…19 Despite approval of 12 agents by the FDA for treatment of relapsing remitting MS, the cost of disease modifying treatments has continued to rise 49 and the proportional cost of DMTs relative to total cost of care has not changed from 2004 to 2011. 19 As the frequency of MS relapses reduces with advancing age, 18 the cost-benefit ratio rises over the life of the patient. Although it is difficult to quantify for an individual patient, discussion of the change in relative benefit of administering DMTs to elderly patients with MS, particularly those with progressive disease warrants discussion with the patient when planning ongoing care.…”

“…DMTs account for 75% of the total healthcare cost of those receiving these drugs in the United States in 2011. 19 The long term safety profiles of glatiramer acetate 20,21 and interferon 1a are excellent. 22 Natalizumab poses a small but important risk of progressive multifocal leukoencephalopathy.…”

Intelligent Design and Imaginary Worlds in Cost-Effectiveness Claims: An Overview of Commentaries in INNOVATIONS in Pharmacy from July 2016 to February 2017

“…Four of the DMTs had annualized cost increases above 20% and four with annualized price increases between 13.0% and 16.8%. Natalizumab, for example, although being withdrawn briefly from the market between 49 . At the same time, the increase for DMTs far outstripped the charges for other medical services (95.7% vs. 32.4%).…”