A new study co-funded by the National MS Society, the National Institutes of Health and the University of Rochester examined the cost-effectiveness of therapies to treat MS, and finds that the cost for improving the quality of life for people with MS in the U.S. is high. The study in no way suggests that anyone appropriate for these treatments should not be on them, and it found that the earlier disease-modifying therapies were used, the more cost-effective they were, adding to growing evidence suggesting that treating MS early and consistently is the best way to ward off future disease activity. Katia Noyes, PhD, MPH, and colleagues (University of Rochester, NY) report their findings in Neurology (published online July 20, 2011).
Background: The management of MS has been substantially advanced by the availability of the disease-modifying agents. The first was approved in 1993, and over the ensuing years, evidence from clinical trials and prescription use has shown their effectiveness in reducing the number and severity of MS attacks and slowing disease progression. Although they do not work for everyone, for many individuals they have profoundly enhanced their ability to stay active and productive.
In 2004 the National MS Society released a request for proposals with the goal of developing a way to analyze the cost-effectiveness of disease-modifying therapies used in the U.S. The goal of cost-effectiveness research is to determine what it actually costs to produce a given amount of increment in quality of life. In the U.S., there is no standard or official threshold for what is considered “cost effective” therapy, as it is extremely difficult to put a price on what enhanced quality of life can mean to individuals living with a chronic illness.
After a competitive peer review process that engaged experts nationwide, a contract was awarded to Dr. Noyes, a health services researcher at the University of Rochester. This contract focused on the four approved disease-modifying therapies in the U.S. available for treating MS at the time: interferon beta-1a (intramuscular and subcutaneous forms); interferon beta-1b; and glatiramer acetate. Read more about currently approved MS therapies.
The Study: The team developed and tested an experimental statistical model of cost-effectiveness using data from the National MS Society’s Sonya Slifka Longitudinal MS Study, a national sampling of people who have MS. The team gathered data on subsets of participants, looking at health care costs, lost work time, and other factors, and their use of disease-modifying MS therapies. The team used a 4-year window to estimate disease outcomes, costs and cost savings over 10 years. The group determined how treatment affected quality-adjusted life years, which measure the number of years that would be added by using a drug and the quality of life during those years.
The investigators found that under current prescribing and pricing conditions in the U.S., the disease-modifying therapies help people with MS, but that the extent of improvement in quality-adjusted life appears to be modest compared to the high costs of these therapies, when based on the study’s analytic model. They also found that starting treatment earlier was associated with a more favorable cost-effectiveness ratio compared to initiating treatment at any phase of the disease. This study was not a clinical trial and did not measure whether these therapies altered disease progression that can lead to severe disability.
Conclusion: This study is a snapshot in time examining the potential cost effectiveness of MS therapies. It provides one piece of a complex puzzle, but there remains a need for more research to better understand the longer-term effects of the MS therapies and their benefits on the most disabling aspect of MS, which is disease progression.
The study offers support for the widely held belief that MS therapies are expensive. Like other health policy research supported by the National MS Society, this and other studies give us concrete information to raise awareness and to advocate for bringing down the overall cost of health care.
The National MS Society’s National Clinical Advisory Board recommends that everyone diagnosed with MS, as well as those showing early signs strongly suggestive of MS, consider going on, and staying on, a disease-modifying therapy.
The Society has always focused on helping to ensure that people with MS have access to the therapies they need. This includes working with them to try and find options such as patient assistance programs and/or insurance coverage. Read more about how we can help.
The Society continually advocates for affordable MS treatments in all arenas including the pharmaceutical industry, insurance providers and the government. At the state level, the Society is advocating to limit the amount an individual with MS must pay for the disease modifying therapies. Read more about advocacy efforts.