Yesterday afternoon, news outlets were announcing the result of a 10-year study on the cost-benefit of MS treatments published online in Neurology. In reading the news coverage (because the study itself is available only to subscribers to the journal), it appears that cost-effectiveness or Quality-Adjusted Life-Years (QALY) was not the only measure taken. It was determined that earlier treatment was more cost-beneficial over time.
The study did suggest that lowering the price of MS drugs (Avonex was used as an example) by 67% would bring their QALY cost to an amount more in-line with what is acceptable in the United Kingdom where NICE helps to control price and access to medication treatments. One commenter on an article shares that these drugs cost 1/4 the US prices in Israel where there are only 4000 MS patients.
You can read coverage in Reuters, Bloomberg, New York Times, Los Angeles Times, Washington Post, U.S. News & World Report, FiercePharma, Science Daily, Corante, Pharmalot, WebMD and the National MS Society who helped to sponsor the study.
[Note that there must have been an embargo on this news release until around 4:30PM yesterday. I must not be on the right press release mailing lists, certainly not the same ones as the "big" news outlets.]
Here are several posts where we've already discussed the price of MS drugs:
Gilenya Priced at $4000/month, 30-50% Higher than MS Self-injections (October 2010)
At that time, the four main MS disease-modifying treatments ranged in cash price from $34,667-$39,928. Gilenya was introduced in September with a price of $48,000.
The Rising Price of MS Disease-Modifying Medications (March 2011)
Between October and March, the other MS-related drug companies raised their prices. The four main self-injectable drugs ranged in price from $34,980-$45,140 with Gilenya (the only oral pill, taken daily) at $48,000.
When I was first prescribed Copaxone in December 2005, it was priced at $18,000. Now it is $45,048/year, a price which is 2.5 times higher in cost in less than six years.
Now when trying to determine what exactly are the prices of these drugs, it becomes a game. I had previously used the same website/online pharmacy to determine the price of these medications. But drugstore.com no longer provides information on Copaxone or Rebif. So I have to turn to a different source, destinationrx.com, which could alter my price comparisons over time.
For instance, today drugstore.com prices Avonex at $3029/box where destinationrx.com prices Avonex at $3307/box. Gilenya compares at $3880/month and $4268/month, respectively. Betaseron at $2990/box and $6661/month (which I believe is actually enough medication for two months). Destinationrx lists Copaxone at $3754/month and Rebif at $3338/month. The variations continue....
Using destinationrx numbers, the range of prices for MS disease-modifying drugs today (not including Tysabri) is $39,966-$51,216. Just imagine if the prices were lowered by 67%!! $13,189-$16,901 would actually seem rather reasonable. I'm sure that the insurance companies would prefer that. But maybe not, because why else wouldn't they be better at negotiating lower costs for their "customers" when it comes to drug prices.
Money Spent on MS Drugs Continues to Rise, But Do You Know How Much? (April 2011)
"The total amount spent on MS medications increased 25.4% from 2009-2010. The amount had increased 34.4% from 2008-2009 and 18.3% from 2007-2008. The result is an amount spent in 2010 on MS medications which is double what what spent in 2007. Double in three years. If forecasts are correct, the amount spent on MS drugs will more than double again in three years. "
One of the news articles I have read regarding the Neurology study, the author referenced an accompanying editorial which stated that "...costs may naturally go down with the advent of more oral DMTs (as opposed to the injectables that are primarily in use now) and as drug company patents expire and generics are introduced. " My opinion is that this editorial author is confused with what SHOULD happen in a normal market for medications. The market for MS medications is anything but "normal."
The MS Relapse is Not So Inexpensive (June 2008)
After receiving the EOBs following a 5-day IVSM treatment and a trip through the MRI machine, I learned that one relapse resulted in $6000 of adjusted medical costs. This did not include time off work or any other financial effects of a single relapse. Just the medical costs which were originally billed at $10,500. Absolutely crazy.
The Value of Money or the Value of Health - What do you see? (January 2008)
From December 2005 to January 2008 (two years later), Copaxone's price had increased from $18,000 to $21,000. A bargain by today's pricing standard for MS drugs.
Here is the abstract of the Neurology article/study:
Cost-effectiveness of disease-modifying therapy for multiple sclerosis
A population-based study
K. Noyes, A. Bajorska, A. Chappel, et al.
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.
(To access the full study, the price is $20/day for nonsubscribers.)