Patients with multiple sclerosis (MS) tend to incur more medical costs after switching to injectable therapies.
“Overall health care costs for MS patients increased significantly after starting infusion DMT. [disease-modifying therapies] “Including Ocrebus, Tysabri and Lemtrada,” the scientists wrote.
Findings suggest that most of the increase is due to medication, and the researchers suggest that controlling the markup could keep patients’ healthcare costs down. We also found that infusions tended to be cheaper than infusions at hospitals and clinics.
“This study expands our understanding of the real cost of IV. [intravenous] DMT will assist providers and patients with treatment selection and help US payers guide formulary decisions,” the scientist said.Cost of Actual Care and Location of Care for Multiple Sclerosis Patients Starting Infused Disease-Modifying Therapywas published in Journal of Medical Economics. This work, Novartissells Kesimpta (ofatumumab), a multiple sclerosis treatment that is administered under the skin.
More than 20 disease-modifying therapies are approved for the treatment of relapsing forms of MS. These drugs help dampen the inflammatory attacks on the nervous system that cause the disease, reduce the risk of recurrence, and slow its progression.
Some approved DMTs are taken orally, injectable, and administered by a steady infusion (infusion) into the bloodstream. From an economic standpoint, a consideration inherent in fluid therapy is that it must be prepared and administered by a medical professional. This means that the administration of therapy may incur medical costs.
Comparison of first-year medical costs of three injectable DMTs
Scientists from Novartis and other institutions examined insurance data to assess the medical costs of patients starting infusion DMT (IV DMT). Using a commercial insurance database called the HealthCore Integrated Research Database, the researcher identified patients who started IV DMT from April 2017 to July 2019.
The analysis included data from 1,058 patients treated with Ocrevus, 166 with Tysabri, and 46 with Lemtrada. Comparing his year before starting IV DMT with his first year of treatment, we found that medical costs increased significantly after starting three modalities.
With Ocrevus, average medical expenses increased from about $68,000 the year before to over $125,000 in the first year and nearly $110,000 in the second year.
With Tysabri, the average cost increased from about $53,000 to over $117,000 in the first year and $106,000 in the second year.
Lemtrada’s average cost increased from about $87,000 to about $180,000 in the first year and to $108,000 in the second year. The particularly high spike in the first year of Lemtrada may be related to its dosing schedule. It is given in higher doses and involves more injections during the first year.
For all three agents, the cost of the treatment itself was the main reason for the high cost. Medication costs alone accounted for more than three-quarters (78%) of his total costs in all three groups.
Markup and Outpatient Fees
Researchers emphasized that the actual cost that insurance companies paid for these drugs was significantly higher than the list price of the treatment.
“IV DMT costs and [list price] The researchers wrote, noting that it is important to consider these markups when evaluating the overall cost of treatment.
The best markup was seen in Ocrevus. The prices paid by insurance companies were on average about 60% higher than the list price for treatment ($104,853 vs. $65,000).
“Pharmaceutical costs, including price increases in the supply chain to patients, are a major contributor to overall healthcare costs for MS patients using IV DMT,” the researchers wrote.
Injectable drugs can be administered at a doctor’s office, an outpatient hospital clinic, or at home. A cost comparison in this study showed that home infusions tended to be less expensive than medical centers. Hospital outpatient infusions were the most common, but also the most expensive.
Part of the increase in costs associated with hospital IV fluids is probably because patients generally receive more services, the researchers said, adding hospital centers add additional costs that can inflate costs. It may also contain markup.
“Depending on how the drug is obtained, hospital outpatient facilities include an additional markup in the price of the drug (profit, tax, etc.), charged to the patient’s health insurance, and an administrative fee (“buy and charge”). ”) may be added. ” writes the researcher. “We move patients away from more costly hospital outpatient departments, negotiate site-neutral pricing for specialty drugs, and use DMTs that don’t require infusion-related resources (e.g., oral/self-injection DMT). That could help reduce health care costs.”
The researchers noted that a limitation of the analysis was that the database only covered patients with commercial insurance, and that the results were “uninsured or well-insured, and those with government-sponsored health insurance.” It may not be generalizable to people who are not affiliated with the
