All-Cause Health Care Utilization and Costs Associated with Newly Diagnosed Multiple Sclerosis in the United States.
Carl V. Asche, PhD, MBA; Mendel E. Singer, PhD; Mehul Jhaveri, PharmD, MPH;
Hsingwen Chung, BS Pharm, MS; and Aaron Miller, MD
What this study adds
· This is the first such study to assess the direct health care costs and resource utilization among newly diagnosed MS patients compared with healthy members of commercial health plans. Overall medical costs were 4.7 times higher for newly diagnosed MS patients.
· Less than one-half of the nearly $19,000 in the first 12 months of costs after diagnosis of MS could be attributed to medical claims with diagnosis codes for MS in any field on the claim.
· MS injectable drugs accounted for approximately one-fourth of total direct medical costs for newly diagnosed MS patients in the first 12 months after diagnosis.
OBJECTIVE: To estimate the additional health care utilization and costs in otherwise healthy patients with newly diagnosed MS.
RESULTS: Mean Health Care Expenditures in 12-Month Post-Index Period
|
Health Care Expenditures
by Service Category
|
MS Patients n=1,411
|
|
Mean (SD)
|
Dollars
|
|
Inpatient services
|
4,110
|
19,673
|
|
MS diagnosis on claim
|
1,802
|
12,846
|
|
Emergency room services
|
432
|
1,290
|
|
MS diagnosis on claim
|
53
|
354
|
|
Injections, MS drugs
|
137
|
1,605
|
|
Physician visits, all
|
849
|
879
|
|
MS diagnosis on claim
|
265
|
366
|
|
Neurologist visits
|
615
|
4,244
|
|
MS diagnosis on claim
|
153
|
297
|
|
Laboratory services
|
409
|
990
|
|
MS diagnosis on claim
|
82
|
318
|
|
Radiology services
|
1,693
|
3,801
|
|
MS diagnosis on claim
|
705
|
1,720
|
|
PT/OT/speech, swallowing
|
295
|
1,019
|
|
MS diagnosis on claim
|
75
|
602
|
|
Other outpatient services
|
4,753
|
11,209
|
|
MS diagnosis on claim
|
1,285
|
4,213
|
|
Outpatient pharmacy
|
6,151
|
8,574
|
|
MS drugs
|
4,436
|
7,828
|
|
Anticonvulsants
|
165
|
701
|
|
Antidepressants
|
194
|
479
|
|
Antipsychotics
|
24
|
253
|
|
Urinary antibiotics
|
3
|
23
|
|
Amphetamines
|
81
|
444
|
|
Adrenals
|
24
|
144
|
|
Other
|
1,225
|
3,070
|
|
Total
|
18,829
|
28,973
|
|
Claims with MS diagnosis or treatment
|
8,839
|
17,825
|
CONCLUSIONS: Newly diagnosed MS patients have significantly higher rates of hospitalizations, radiology services, and ER and outpatient visits compared with non-MS “healthy comparison” patients. MS presents a considerable burden to the U.S. health care system within the first year of diagnosis.
Comparing the Cost-Effectiveness of Disease-Modifying Drugs for the First-Line Treatment of Relapsing-Remitting Multiple Sclerosis
Lawrence D. Goldberg, MD, MBA; Natalie C. Edwards, MSc; Contessa Fincher, MPH, PhD; Quan V. Doan, PharmD, MSHS; Ahmad AL-Sabbagh, MD; and Dennis M. Meletiche, PharmD
What this study adds
· This economic model, constructed using data from pivotal randomized placebo-controlled clinical trials, predicted that patients with RRMS would experience 2.55 relapses and 0.44 disability progression steps over a 2-year period without DMD treatment.
· Over 2 years, for treatment with glatiramer acetate, IFN β-1a IM injection, IFN β-1a SC injection, and IFN β-1b, respectively, reductions in number of clinical relapses were estimated at 0.66, 0.42, 0.74, and 0.70, respectively. Reductions in number of disability progression steps were estimated at 0.05, 0.15, 0.12, and 0.11, respectively.
· IFN β-1a SC injection, IFN β-1b SC injection, and glatiramer acetate have the most favorable estimated costs per relapse avoided ($80,589; $87,061; and $88,310; respectively), and IFN β-1a IM injection has the least favorable cost-effectiveness ratio ($141,721 per relapse avoided).
· This model differs from those previously published because it (a) used a 2-year time horizon based on 2-year pivotal, randomized, double-blind, placebo-controlled clinical trial data without extrapolating to a 5-year or lifetime time horizon; and (b) measured as the primary endpoint relapses averted rather than endpoints that rely on the perception and measurement of preference, such as QALYs.
OBJECTIVE: The primary objective of this analysis was to evaluate the 2-year cost-effectiveness of 4 disease modifying drugs (DMDs) used as first-line treatment of RRMS: glatiramer acetate, interferon (IFN) β-1a IM injection, IFN β-1a SC injection, and IFN β-1b SC injection.
RESULTS: Base-Case Results: Discounted Per Patient Clinical Outcomes, Costs, and Savings Over 2 Years.
|
|
Glatiramer Acetate
|
IFN β-
1a IM
|
IFN β-
1a SC
|
IFN β-
1b SC
|
No DMD Treatment
|
|
Clinical outcomes
|
|
|
|
|
|
|
Relapses
|
1.88
|
2.13
|
1.84
|
1.81
|
2.55
|
|
Relapses avoided
|
0.66
|
0.42
|
0.74
|
0.70
|
-
|
|
Disability progression steps
|
0.40
|
0.30
|
0.33
|
0.33
|
0.44
|
|
Disability progression steps avoided
|
0.05
|
0.15
|
0.12
|
0.11
|
-
|
|
Costs and Savings
|
|
|
|
|
|
|
Medical cost: relapses and disease progression
|
$9,537
|
$10,513
|
$9,060
|
$9,231
|
$12,733
|
|
Medical savings
|
$3,196
|
$2,221
|
$3,673
|
$3,502
|
-
|
|
Cost of DMD therapy
|
$49,068
|
$48,473
|
$50,389
|
$52,010
|
$0
|
|
Total MS-related cost
|
$58,605
|
$58,986
|
$59,449
|
$61,241
|
|
|
Cost per relapse avoided
|
$88,310
|
$141,721
|
$80,589
|
$87,061
|
-
|
CONCLUSION: This evaluation suggests that IFN β-1a SC injection, IFN β-1b SC injection, and Glatiramer acetate represent the most cost-effective DMDs for the treatment of RRMS, where cost-effectiveness is defined as cost per relapse avoided, assuming that (a) the RRR in relapses and disease progression steps calculated from multiple DMD placebo-controlled clinical trials reflect real differences among DMDs over 2 years; and (b) resource unit costs derived from published sources reflect economic consequences of relapses and disease progression.
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