The cost of treating MS

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One of my patients recently asked if they could return their tablets back to stock as they had decided not to make the swap as initially planned. Of course, the tablets could not be returned, and it’s a couple of hundreds of pounds down the tube. The patient was not to blame for this. Why should a tablet be worth more than the currency of gold?

In fact, unanimously high cost drugs top all other medical and/or surgical care available to date. There is nothing more informative than a graph where the trend is on the up and up.

Whilst, Jo blog thinks about the present, the world is definitely moving on.

This is bigger than Trump, Brexit, and yo-yoing oil prices, and it’s happening right in front of our own eyes.

At this rate, is future healthcare sustainable?

Fig. 1. Scatter plot shows costs (EUR per patient, per year) for DMT prescription and management over time (red dots). Predicted slope change (blue line) is shown in relation to different interventions (dashed green line): 2007 (Natalizumab), 2011 (oral tablets), and 2015 (Alemtuzumab) (for conversion purposes, 10,000 EUR correspond to around 11,500 USD).

Abstract

Mult Scler Relat Disord. 2019 Nov 9;38:101514. doi: 10.1016/j.msard.2019.101514. [Epub ahead of print]

The impact of diagnostic criteria and treatments on the 20-year costs for treating relapsing-remitting multiple sclerosis.

Petruzzo M, Palladino R, Nardone A, Nozzolillo A, Servillo G, Orlando V, De Angelis M, Lanzillo R, Brescia Morra V, Moccia M.

OBJECTIVE:

To assess whether the introduction of the new diagnostic criteria and disease modifying therapies (DMTs) is associated with higher cost for treating multiple sclerosis (MS).

METHODS:

This is a regression-based quasi-experimental study employing interrupted time series analysis, including data from 2229 patients (age 42.1 ± 11.2 years; female 63.34%), with incident diagnosis of relapsing remitting MS (RRMS) and followed up from 1997 to 2017, extracted from the database of the MS Clinical Care and Research Centre of the Federico II University Hospital of Naples (Italy). Annual healthcare costs for DMT (e.g., prescription, staff involved in DMT administration) and management (e.g., neurological consultations, other consultations related to DMT safety, MRI, laboratory exams), were calculated and inflated to the most recent value.

RESULTS:

Annual costs per patient for DMT prescription and management were not affected by the introduction of 2001 and 2005 criteria, but decreased by 0.4% after the introduction of 2011 criteria (PD= -0.4%; 95% C.I. -0.7%/-0.0%; p = 0.023). Annual costs per patient increased by 11.2% after the introduction of Natalizumab in 2007 (PD= 11.2%; 95% C.I.= 9.4%/13.0%; p <0.001), by 10.9% after the introduction of tablets in 2011 (Fingolimod, Teriflunomide and Dimethyl Fumarate) (PD= 10.9%; 95% C.I. 9.2%/12.7%; p<0.001), and by 10.7% after the introduction of Alemtuzumab in 2015 (PD= 10.7%; 95% C.I. 9.0%/12.4%; p< 0.001).

DISCUSSION:

DMTs remain the main responsible for increased medical direct costs in MS, whilst improved diagnostic skills and subsequent patient profiling can at least in part mitigate costs for MS treatment and management.

About the author

Neuro Doc Gnanapavan

18 comments

  • That’s true, but the real study should compare the direct costs vs a life with incapacity due to MS.
    A good DMT is not only about initial cost !
    How about funding the treatment for the patients lifespan ? Like a “mortgage”

  • I woke up wondering how I could get my next 90 day allotment of Glatopa shots 💉 before the end of the year because I’ve met my $750 deductible for 2019. Glatopa is he generic of Copaxone, both of which seem old school, so yesterday. But at 61 on Medicare and a Supplement, Why should I expect More?
    There’s something cruel about making me pay $750 USD in January right after Christmas 🎄
    Then I thought about young Serbians, without even Access to DMT’s and I felt Rich, Elite, Privileged. Am I really worth it?
    Now,
    Maybe we can leave President Trump out of this.
    He didn’t devise the ill fated Obama-Care, which put high premiums, deductibles and penalties for not participating.
    He didn’t tout “Medicare for all “ like the Democratic Party Candidates.
    He didn’t give the Legislature better healthcare insurance than their constituents.
    The Legislature did that.
    He didn’t propose employers stop using healthcare as a benefit of employment.
    In fact, that is why some people work.
    I realize I’m rambling in the wee hours but the Healthcare Morass is easy to get stuck in.
    A system so complicated and so emotionally charged,
    A system we rely on to give us Health and Life.
    A system of Incrementalism.
    A battle of Legislative Priorities.
    Lobbyists from Pharma and Healthcare systems compete to buy the lawmakers drinks 🍷
    I sit here typing letters to my legislators and get a generic “Thanks for sharing “ email back.
    You may not want to hear my theories about Gadolinium, a rare earth toxic metal used for better MRI pictures.
    In fact, no one wants to talk about it.
    Isn’t that part of the problem when the USA FDA , Food and Drug Administration can get thousands of patient reports of ill effects of Gadolinium while big Corporations like Bayer, GE, Make bazillions pushing this toxic metal?
    The source Of Gadolinium is China, where God only knows how it is mined and refined.
    Nobody is listening as I sing like a canary, “Gad is Bad”.
    Meanwhile consider your municipal drinking water supply probably contains Gadolinium,
    Source? The urinary tracts of MRI Patients.
    The Theme of this Healthcare Quagmire is Money and Profits
    Disregarding Humans and True Science.
    Stay tuned.
    Healthcare “reform” is coming.
    It’s a bitter pill.

  • As crazy as your graph appears for folks on your health care system, here in the US, the price is already in the $96000 plus range. That is already not sustainable. When I read articles about DMTs, the number crunchers flat out say that it is cheaper to deny the meds and allow patients to get more disabled as addressing the disability is cheaper. That is the world we live in. That number cruncher approach of course assumes that the prices that pharma puts on the DMTs are fair or even reflective of the actual development cost plus a reasonable return on investment. Obviously those prices do NOT reflect that. That is why governmental regulation or a public health care system is the only way to disengage profit from health.

  • Yup, interesting to see all these American comments.

    Both Republicans and Democrats in the House of Senates are in favour of killing off the unique buying power of the NHS in return for a post-Brexit trade deal.

    Things in Blighty are about to get real, bruv. This blog needs to address this realness.

    Vote Labour, blud. Register today.

    • What is a blud and how do I spot one? I get the impression they are boss eyed and can’t spell. are they the British equivalent of a blood? According to the late Bill Hicks, it’s the Hooligans that you need to be afraid of in the UK. Are you a Hooligan Dr Dre?

  • The Pharma investment strategy is to pass their investment risks from new research and drug development on patients and national insurances, by getting “pre-paid”(!), rather than taking those investment risks on the company budget -as companies are supposed to do.
    What they do is create an environment of “shared benefits” to blur the fact that they are actually the most grossing capitalistic companies of our times and by far the most cruel ones. That the “free economy” at its best.

    • Fair point. Sure the list price sets the market trend, so to speak. But, often drugs are offered on rebate or discounted. So the investors play a big role like any company.

  • I live in Australia. Year 1 alemtuzumab = $0 out of pocket. Drug fully paid for by Medicare. Accessed as first line treatment. As I’ve said many times, I’m so glad I live in Australia. We are top of the list concerning DMT access and low cost.

    No if we could only fix our dental system fixed….

      • Yep, ambulances are charged for (approx $500-$1000) in most states of Australia, with pensioners, health care card holders etc exempt, also covered by private health insurance.
        Still glad to live here just done year 1 on cladribine as first line treatment, for $40.30 out of pocket, the balance paid for by Medicare.
        But definitely agree about the dental system needing to be fixed.

      • Yep but basic private health insurance ($300 per year) covers this if required. Go to hospital in an ambulance, leave without a hospital bill. Compare that to the US where a hospital stay can bunkrupt people. I know which system I’d prefer.

        • Yeah, sorry I didn’t make myself clearer, I am more than happy to trade the potential cost of an ambulance/basic private health care for free hospital care and the opportunity to access drugs for the cost of a good lunch (or less) with relatively few restrictions on who can receive what drug.

    • Yes, this article provides a unique insight into this process. As long as there’s no push back the price hikes will continue…and in a bizarre way some of the ludicrous new price hikes may be in preparation of this curbing in prices that the companies expect in the future. The rules of bartering are don’t barter something you don’t want to give, equally don’t barter for something you don’t want. Clearly the US Market is former, whilst the European state provided healthcare is the latter!

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