According to a study released this Wednesday, drugs used in the hope of slowing multiple sclerosis progression may help some patients, but at a very high cost.
These drugs are termed “disease-modifying drugs (DMDs)” and have been available since the 1990s to treat multiple sclerosis. They include beta interferons (brand-names like Avonex, Rebif and Betaseron), glatiramer (Copaxone) and natalizumab (Tysabri). They are given by injection or infusion and can help prevent MS symptom flare-ups and delay long-term disability from the disease. Each of these drugs now cost upwards of $3,000 a month in the U.S.
The latest study appeared in the journal Neurology and it estimates that people who use the medications for a decade would get only a modest health benefit for the money. They would gain an extra two months or less of good health over 10 years, the researchers say, compared with using only therapies that help ease MS symptoms -- like medications for pain, fatigue and muscle spasms. Overall, the study estimated, DMDs cost close to $1 million for each year of relatively healthy life a person with MS could expect to gain with 10 years of use. In contrast, common thresholds used to define a “cost-effective” treatment range between $50,000 and $150,000 for each good-quality year of life gained the researchers explained.
Katia Noyes, a researcher at the University of Rochester in New York who led the study said the figure for DMDs is an “order of magnitude higher” but the findings do not mean that people with MS shouldn't take the drugs. She added, “This study was not designed to try to deprive people with MS of any therapy.” It was not intended, she said, to tell doctors what to prescribe or insurance companies what to pay for.
She added that the purpose was, to allow for more studies to look at the value of different medical therapies, and what factors seem to affect their cost-effectiveness for patients overall. In the case of DMDs for MS, she said, starting earlier in the course of the disease appears to be better. “The main benefit of these drugs is in the long-term,” she said. “That may be 10 or 20 years down the road.”
Noyes also pointed out that MS is “not unique” in having therapies with a high price for the benefit. Other examples include implanted defibrillators for people at high risk of cardiac arrest, many cancer treatments and some arthritis therapies. And there are many medical interventions, Noyes said, whose cost-effectiveness has never been studied.
Kathleen A. Smyth, a researcher at the Neurological Outcomes Center at Case Western Reserve University in Cleveland said, “The good news from this study is that these drugs do seem to be effective, on average…The bad news is, these positive outcomes come at a very high price.” Smyth wrote an editorial published with the study. People already on the MS drugs know well the high costs, she noted in an interview, but the price tag might come as a shock to new patients. However, Smyth said, people with MS need to make treatment decisions on an individual basis, after discussions with their doctor and not based on cost alone.
“I don't think there's anything in this study that should stop people from getting an early diagnosis or starting treatment,” Smyth added. She also noted that the picture may change in the future. When individual DMDs' patents eventually expire, for example, the cost of some could well come down. And then certain medications may become preferred by insurance companies. As it stands, Smyth said, no particular DMD stands out as a “best buy” for Americans.
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