Economics and Cost-Effectiveness of Multiple Sclerosis Therapies in the USA

Abstract

Multiple sclerosis (MS) is a disabling, chronic disease that imposes a significant economic burden on patients and the US healthcare system. The largest cost component for individuals with MS are prescription drugs, specifically disease-modifying therapies (DMTs). Despite an increase in the number and diversity of DMTs over the past 10 years, acquisition costs for all DMTs have escalated dramatically at rates substantially higher than medical inflation. Currently, costs for most DMTs exceed $70,000 a year. Recent cost-effectiveness studies suggest the cost for nearly all DMTs exceeds generally accepted thresholds for what is considered a good value in the USA, even after factoring expected rebates. The high cost of DMTs is symptomatic of systemic dysfunction in the pharmaceutical market. Strategies aimed at reigning in high-cost medications include proposals ranging from increasing pricing transparency to allowing Medicare to negotiate directly with manufacturers. Because the economics of pharmaceuticals are inherently complex, a diversity of approaches will be required.

Keywords: Healthcare economics; disease modifying therapy; multiple sclerosis; pharmaceuticals.

Fig. 1

Schematic of the flow of money and drug product in the drug distribution system. Sold lines represent drug product movement. Dashed lines represent payments. Figure adapted from Academy of Managed Care Pharmacy Guide to Pharmaceutical Payment Methods (2013 Update). AMP = Average Manufacturer Price; WAC = Wholesale Acquisition Cost

Fig. 2

Trends in disease modifying therapy (DMT) pricing. Pricing estimated from WAC for year of therapy. Alemtuzumab estimate is based on average of first- (60 mg) and second-year dose (36 mg) IFN = interferon; SC = subcutaneous