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Commentary: Cost/benefit of DMDs

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  • Commentary: Cost/benefit of DMDs

    This was just published in the journal Neurology. What does all this mean? Well, for starters, our drugs are hella expensive....

    Cost-effectiveness of disease-modifying therapy for multiple sclerosis
    A population-based study

    K. Noyes, PhD, MPH, A. Bajorska, MS, A. Chappel, PhD, S.R. Schwid, MD, L.R. Mehta, MD, B. Weinstock-Guttman, MD, R.G. Holloway, MD, MPH and A.W. Dick, PhD
    + Author Affiliations

    From the Departments of Community and Preventive Medicine (K.N., A.B., A.C.) and Neurology (S.R.S., R.G.H.), University of Rochester, Rochester, NY; Evergreen Neuroscience Institute (L.R.M.), Kirkland, WA; Jacobs Neurological Institute (B.W.-G.), SUNY University at Buffalo, Buffalo, NY; and Rand Corporation (A.W.D.), Pittsburgh, PA. Dr. Chappel is now at the Office of the Assistant Secretary for Planning and Evaluation, HSD HHS, Washington, DC.
    Address correspondence and reprint requests to Dr. Katia Noyes, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Ave., Box 644, Rochester, NY 14620


    Objective: To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) in the United States compared to basic supportive therapy without DMT for patients with relapsing multiple sclerosis (MS).

    Methods: Using data from a longitudinal MS survey, we generated 10-year disease progression paths for an MS cohort. We used first-order annual Markov models to estimate transitional probabilities. Costs associated with losses of employment were obtained from the Bureau of Labor Statistics. Medical costs were estimated using the Centers for Medicare and Medicaid Services reimbursement rates and other sources. Outcomes were measured as gains in quality-adjusted life-years (QALY) and relapse-free years. Monte Carlo simulations, resampling methods, and sensitivity analyses were conducted to evaluate model uncertainty.

    Results: Using DMT for 10 years resulted in modest health gains for all DMTs compared to treatment without DMT (0.082 QALY or <1 quality-adjusted month gain for glatiramer acetate, and 0.126–0.192 QALY gain for interferons). The cost-effectiveness of all DMTs far exceeded $800,000/QALY. Reducing the cost of DMTs had by far the greatest impact on the cost-effectiveness of these treatments (e.g., cost reduction by 67% would improve the probability of Avonex being cost-effective at $164,000/QALY to 50%). Compared to treating patients with all levels of disease, starting DMT earlier was associated with a lower (more favorable) incremental cost-effectiveness ratio compared to initiating treatment at any disease state.

    Conclusion: Use of DMT in MS results in health gains that come at a very high cost.

    Received May 14, 2010.
    Accepted February 18, 2011.

    From the NYT:

    Study Examines High Drug Costs vs. Benefits for M.S. Patients

    The biotech drugs used to treat multiple sclerosis produce health benefits that come at an exorbitant cost, according to a new study published on Wednesday.

    The drug are about 10 times as expensive as what would generally be considered cost-effective, according to the study, published online by the journal Neurology.

    “These are very expensive and marginally effective,’’ said Katia Noyes, chief of the division of health policy and outcomes research at the University of Rochester School of Medicine. She is the lead author of the study.

    In a commentary published by the journal, Kathleen A. Smyth of Case Western Reserve University said the cost in relation to benefits of the multiple sclerosis drugs was “far higher’’ than for treatments for other chronic diseases.

    Full Article:
    Dave Bexfield

  • #2
    The "good news" in a commentary published in the same issue. - Dave


    "The good news from this study is that these drugs do seem to be effective, on average," said Kathleen A. Smyth, a researcher at the Neurological Outcomes Center at Case Western Reserve University in Cleveland.

    "The bad news is, these positive outcomes come at a very high price," said Smyth, who wrote an editorial published with the study.

    People already on the MS drugs know well the high costs, she noted in an interview, but the price tag might come as a shock to new patients.

    However, Smyth said, people with MS need to make treatment decisions on an individual basis, after discussions with their doctor -- and not based on cost alone.

    Like Noyes, she pointed out that earlier treatment appeared more effective in this study. So while it may ultimately cost more, starting a DMD earlier may benefit patients more.

    "I don't think there's anything in this study that should stop people from getting an early diagnosis or starting treatment," Smyth said.

    Full article (Reuters):
    Dave Bexfield