#AANAM — DMTs Primarily Responsible for Rising Healthcare Costs for MS Patients, Study Suggests

A trend of rapidly increasing costs for disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) appear to be the primary driver behind the overall rise in healthcare costs for people with MS, a study suggests.

These data were presented in a poster titled “Trends for Healthcare Cost among Commercially Insured Individuals with Multiple Sclerosis” at the 2019 American Academy of Neurology (AAN) annual meeting, taking place May 4–10 in Philadelphia. 

The research was also recently published in the journal Multiple Sclerosis And Related Disorders, in an article titled “Disease modifying therapies continue to drive up health care cost among individuals with multiple sclerosis.”

In recent years, more DMTs have been developed and approved for MS treatment. However, the cost of these treatments can be a major obstacle for patients.

“Our concern is the drug cost of DMTs is continuing to grow,” Youngran Kim, who presented the data at the AAN meeting, said to Multiple Sclerosis News Today. Kim is a researcher at the University of Texas Health Science Center at Houston School of Public Health.

To figure out exactly how DMT costs have changed in recent years — and how these changes compare with other costs faced by people with MS, such as those associated with hospital visits — the investigators analyzed data from Truven MarketScan, a database with information from commercial insurance.

They specifically looked at costs from 2011 to 2015, with a focus on MS patients younger than 65 and for whom at least a year’s worth of data was available. The exact number of patients with available data varied from year to year, from a maximum of 49,439 in 2011 to a minimum of 32,840 in 2015.

Researchers then broke down the costs into four categories: inpatient hospital visits, outpatient visits, DMTs, and other prescriptions. Total amounts paid by insurance and the patient were taken into consideration. All costs were adjusted for inflation to 2015 dollars.

Overall, over the five years analyzed, the annual healthcare cost per MS patient increased from $45,471 in 2011 to $62,500 in 2015 — an 8.3% average annual growth rate.

When looking at each of the four categories individually, data showed that the average cost of hospital visits remained fairly consistent or decreased — about $3,580/year for inpatient visits, and about $10,640/year for outpatient visits. The cost of non-DMT prescriptions was also stable at approximately $4,400/year.

In contrast, the average cost of DMTs rose dramatically, from $26,772/year in 2011 to $43,606/year in 2015 — a 13% average annual growth rate. This was accompanied by a slight, though significant, increase in the percentage of MS patients taking at least one DMT — from 77.3% in 2011 to 80% in 2015.

The annual healthcare costs per DMT user in 2011 were 74% higher than those of non-DMT users ($50,352 vs. $28,881), increasing to more than twice that in 2015 ($70,683 vs. $29,821).

These results suggest that the overall increase in annual healthcare costs is directly linked to a rise in DMT costs.

In theory, these increasing costs could be indicative of more advanced therapies becoming available, but, interestingly, the data show that this is not the case.

“These trends happen not just in the new DMTs,” and are “not only limited to MS patients on new DMT drugs approved by the FDA, but also applied to those on previously available DMTs,” Kim said.

For example, she said, the DMT interferon-beta 1b increased from an average cost of $32,502 in 2011 to $50,353 in 2015. Interferon-beta 1b is marketed by Bayer Healthcare under the brand name Betaseron and was approved by the U.S. Food and Drug Administration for MS treatment in 1993.

Based on the results, Kim concluded, the “annual healthcare costs for MS patients increased rapidly between 2011 and 2015, almost entirely due to the cost of DMTs. Older drugs as well as newly approved DMTs both drove this trend.”

Notably, these trends are only found in the United States — in Europe, for example, the costs of DMTs are subject to more strict regulation that prevents such high increases, according to Kim. Additionally, the costs analyzed are those charged, not necessarily those paid by the patients, since insurance may cover some or all of the costs.