Health economics of disease-modifying therapy for multiple sclerosis in the United States

Abstract

Multiple sclerosis (MS) is chronic neuroinflammatory condition associated with significant disability. The economic burden of MS is substantial, and high and rising disease-modifying therapy (DMT) prices are the single largest drivers of healthcare expenditures. Over much of the last decade, price increases for most DMTs have surpassed 10% annually. Currently, many MS DMTs exceed US$90,000 a year and their economic value is widely debated. In addition to creating a financial burden for the healthcare system, high DMT costs negatively impact patients through unaffordable out-of-pocket costs and excessive restrictions by insurance companies. The objective of this narrative review is to summarize economic issues related to MS DMTs, including trends in pricing, relative value, and effects on patient care in the United States.

Keywords: disease-modifying therapies; multiple sclerosis; pharmacoeconomics.

Figure 1.

Trends in annual price for DMTs for MS by class; 1997–2020. Unadjusted annual price estimated from wholesale acquisition costs (First Databank). The annual price for Lemtrada is based on four 12 mg vials [Package insert dosing: 12 mg/day (5 vials) for five consecutive days in first year; 12 mg/day (3 vials) for 3 days in year 2]. Market introduction date in parenthesis. Updated 12 August 2020 (data through July 2020). DMT, disease-modifying therapies; MS, multiple sclerosis.