DMTs Are Cost-Effective and Help to Slow MS Progression, 10-Year Study from UK Reports

DMTs Are Cost-Effective and Help to Slow MS Progression, 10-Year Study from UK Reports

Four disease-modifying therapies (DMTs) for  multiple sclerosis — Avonex, Rebif, Betaferon, and Copaxone — are cost-effective and reduce disease progression in MS patients, especially those with relapsing-remitting disease, according to 10-year, real-world results from U.K.’s MS Risk Sharing Scheme (RSS).

But the long-term benefits observed wane over time, and suggest that better outcomes are achieved in patients who are treated earlier and have less disability.

The research, “Assessing the long-term effectiveness of interferon-beta and glatiramer acetate in multiple sclerosis: final 10-year results from the UK multiple sclerosis risk-sharing scheme,” was published in the Journal of Neurology, Neurosurgery & Psychiatry.

The first partnership of its kind in the U.K., the RSS enabled patients to access four DMTs through the country’s National Health Service (NHS) – three formulations of interferon beta, Avonex (by Biogen), Rebif (by EMD Serono), and Betaferon (known as Betaseron in the U.S., by Bayer), and one glatiramer acetate, Copaxone (by Teva Pharmaceuticals).

With help from the MS Trust and other professional and patient groups, the scheme was established in 2002 after the National Institute for Health and Care Excellence (NICE) concluded that, despite evidence of fewer relapses over two-to-three years, it could not recommend these four therapies due to insufficient evidence of cost effectiveness over a 20-year timeframe.

Rather, the treatments became available through the NHS after health officials reached an agreement with the therapies’ manufacturers. The scheme’s “risk” meant a shared financial risk between the NHS and the pharmaceutical companies.

A long-term monitoring study then assessed the medications’ cost-effectiveness over time. The study recruited about 5,000 patients in the U.K., who were given one of the four DMTs between 2002 and 2005, and then were followed for 10 years to compare the long-term benefits of treatment to an untreated “natural history” group of 978 patients in British Columbia, serving as controls.

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“By establishing a novel RSS between the manufacturers and payers, we were able to collect high-quality long-term data on disease progression on a treated cohort and use historical data on untreated patients to construct a comparison control group,” the researchers state.

At six years, all four medications effectively reduced the rate of disability in patients with relapsing-remitting MS (RRMS), and were meeting the pre-specified cost-effectiveness target of £36,000 per quality-adjusted life-year projected out for 20 years.

Final results in 4,862 patients, followed for a median of 10 years, showed that in addition to being cost-effective, these four DMTs provided a stable and clinically significant reduction in disability progression, as assessed using the Expanded Disability Status Scale (EDSS), including a meaningful delay to sustained loss of unaided ambulation (EDSS of 6) of around four years in people with walking difficulties at treatment start.

“This study supports a beneficial effect on long-term disability with first-line MS disease-modifying treatments, which is clinically meaningful. The treatment effects appeared larger for patients with RRMS, those who start treatment earlier in their disease course and for women,” the researchers wrote.

However, the findings also indicated a gradual waning of therapeutic benefit over time, which may not justify the DMTs’ prices in some healthcare systems — particularly where costs are higher, the scientists observed. This may have implications in clinical care of MS and other patients with MS, and may warrant a new clinical study to evaluate whether discontinuing treatment — “after a given period on treatment, or after reaching a given level of disability’ — carries “any disadvantage.”

“On the basis of our findings, it might be more cost-effective — and ultimately in the interests both of patients with MS and of patients with other conditions — to intervene earlier in the disease course, rather than to persist with treatment for long periods,” the team wrote.

Of the 4,862 patients in the analysis, 17 percent switched to “non-scheme” treatments during follow-up, particularly Tysabri (natalizumab, by Biogen) and Gilenya (fingolimod, by Novartis), and 18 percent stopped using their DMTs during the study, the study noted.

David Martin, MS Trust’s chief executive, in a press release called the RSS “a truly innovative scheme” that “continues to deliver real benefits” for MS patients.

“Not only has the scheme enabled over 18,000 people with MS to access disease modifying treatments (DMTs), but it has also been the catalyst for the development of MS services, completely transforming the landscape for the 110,000 people living with MS” across the U.K., Martin added.

These benefits include a marked increase in MS nurses, physiotherapists, occupational therapists and neurologists, as well the opening of 70 specialist MS centers, and better education for health professionals specializing in treating MS patients.

9 comments

  1. Per West says:

    After my diagnosis, I was set on Rebif, and then I really got MS, with new attacks every week, and it stopped, when I throw away the “medicine” after a year.
    How can the doctors treat a disease of which origin they know nothing about.
    They havent even found out, that the lymphatic system is present in every human brain, also the MS’s patients.
    The neurologists is the reason, MS exist.

  2. Linda M. SansSouci says:

    I had my first MS attach (optic neuritis) in 1980, but because I wouldn’t allow an invasive spinal tap, was not diagnosed until 1986, by which time I had had another attack in 1984. I had one more attack in 1988 but it was 1999 when I started Avonex therapy, finally going to an MS Clinic in a University Medical School. I remained on Avonex for 15 years and did quite well. with only one more relapse in 2003. When I retired & lost my health insurance in 2007, Biogen provided the me with the Avonex for 7 more years for no cost under their Access program. At age 71 I stopped the shots and have not taken anything since, although my neurologist & I reassess the now available oral medications every 6 months. I realize I am lucky, but also had to learn how to rehandle my stress level, which had a great deal to do with lessening relapses. I am surprised to learn that it took the UK so long to certify this type of treatment. I would not be functional without it.

  3. $90,000 U.S. dollars retail a year is not cost effective. Nor are 36,000 pounds. It’s extortion.
    I’ve been on Copaxone for at least six years with no waning in results, in fact shrinkage of pre-existing lesions. Negatives that may abound are generated here in the U.S. by the pharmaceutical industry in collusion with the FDA, playing Dr. Death.

  4. Steve Slobodzian says:

    I now see the word `Scheme` identifying treatment. And still see in this publication `the cost effectiveness` term used. I guess that still means that PPMS patients in the UK are denied Ocrevus because it is deemed not to be cost effective. Still wonder how it is branded as not being cost effective when it still is only drug to treat PPMS and it shows effectiveness in slowing disease progression and is helping to alleviate some symptoms to give a better quality of life to people. Hope that the UK will consider approving Ocrevus for people who suffer from PPMS.

    es

    • poppy K says:

      I could not agree MORE. OCREVUS (Ocrelizumab) was, I thought, going to be the wonder drug for those of us with PPMS. Alas, Aust Govt wont fund it for us.

      My neurologist said I wasn’t “bad enough” yet to warrant it! I guess he wants me to be in a wheelchair before doing anything! I do the Waal/Jelnik diet (except that I wont give up the Champagne, red wine and Martinis; I’ve got to have some simple pleasure in life). My PPMS is progressing quite slowly according to the MRI’s. Will spend some of the money I could have spent on OCREVUS, on another cruise. I now LOVE cruising!!

      PS, I ONLY had the lumbar puncture because my cruel sister (a doctor) said she would not believe me unless I had one. Worst 6 weeks of my life after that, crawling around the house as I could not raise my head. All good now.

  5. Martin Matko says:

    Be Pro-Active about eliminating the Cause of the SYMPTOMS of Multiple Sclerosis!!! #CCSVI

    OK what it is………… Multiple Sclerosis is/HAS been an unproven autoimmune THEORY. Neurologists who treat the condition are the so called experts that ‘TREAT’ the so called UNPROVEN autoimmune affliction. Studies have shown that MS Pharmaceuticals Neurologists prescribe are only 20-40% effctive, DO not slow progression and often have harsh corrosive side affects sometimes Death.

    This could be due to the fact that the cause of the unproven autoimmune THEORY is unknown (according to Neurologists). YET! MS Pharmaceuticals that ‘TREAT’ (according to Neurologists) an unknown autoimmune THEORY disease. Has no known cause comprises a $14-60Billion w/ a. B industry according to Studies.

    Possibly you are familiar with Vascular component to the Multiple Sclerosis affliction. Which the Stenosis Condition CCSVI being Scientifically Proven and Confirmed, as Causative factor, in the Pathology of so called Multiple Sclerosis!

    If your veins are blocked they should be opened if you have ms symptoms or not!!! #CCSVI

    CCSVI/Neurovascular Disease is a treatable congenital Science confirmed recognized Medical condition, established causative factor the Symptoms of so called Multiple Sclerosis, AND plays a part/role 43 other so called Neurological afflictions according to studies!

    • Brenda says:

      I had ccsvi and I believe that it works. It just doesn’t give everyone same results. I believe if your veins are blocked then they should be opened. But the medical community can be difficult. They don’t want to cure ms it’s too profitable to treat it. The drugs are very expensive. Do they work ,maybe for some. Injection site infections are horrible.

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