The price tags for a pair of widely used multiple sclerosis treatments would have to be cut by as much as two-thirds in the US in order to be cost effective at increasing the quality of life. Why? The medications are at least eight times more expensive than what is considered reasonable when calculating a quality-adjusted life year, according to a new study in Neurology.
Generally, $100,000 per quality-adjusted life year, or QALY, is considered an acceptable threshold, according to the researchers. QALY is based on the number of years of life that would be added by using a drug. For the MS drugs examined in the study, however, the measure exceeded $800,000 per QALY. For this reason, the study also found prescribing the meds earlier improved cost effectiveness (here is the abstract).
“Simply reducing the price of these drugs to a level for what they’re sold in the UK and Europe will bring the number to a much more acceptable level,” Katia Noyes, lead author of the study and chief of the Division of Health Policy and Outcomes Research at the University of Rochester School of Medicine in New York, tells Bloomberg News.
Among the drugs examined were Biogen's Avonex, Bayer's Betaseron, Teva Pharmaceuticals' Copaxone and Merck KGgA's Rebif. The meds, which delay progression and reduce relapses, cost about $34,000 a year in the US, compared with about $13,000 in the UK, according to the study. MS affects about 400,000 people in the US and 2.1 million globally, according to the National Multiple Sclerosis Society.
The study also found prescribing medicines at earlier stages of the disease improves cost effectiveness. For Avonex, for instance, the cost per QALY when starting the drug at stage two of the disease - which is when most patients start showing symptoms- declines to about $730,000 compared with $898,000 for stage three, Noyes said.
“As soon as they’re diagnosed, if they go on this medication, that will have observable benefit,” she tells Bloomberg. “You can see why people may not do it. They say, ‘This is so expensive, I want to save it as my last resort.’” And this is not as effective as using the meds as a first-line treatment. About half of MS patients avoid the drugs, “probably because cost is a barrier,” she adds.
In response, each drugmaker tells Bloomberg that its med is priced reasonably and is cost effective. For instance, a Biogen spokesman says Avonex “pricing is consistent with the real world value it delivers to patients with MS and...remains the least expensive option for those looking to slow the progression of their MS.”
A Teva spokeswoman complains the study had a “short timeframe” and a “data limitation...multiple sclerosis is a lifelong disease, and when longer timelines that are consistent with the disease are used, the cost per QALY is similar to those in other high-burden illnesses,” she wrote Bloomberg.
And a spokeswoman for EMD Serono, a unit of Merck KGaA, says “the overall clinical benefit of disease-modifying therapies, including Rebif, or interferon beta-1a, have been established in well-controlled Phase 3 clinical studies."
pills pic thx to anolobb on flickr
15 Comments
My sister had MS. The meds kept her out of a wheel chair and driving a hand-controlled car for a long time. You can't put a price on that. Let the bean counters play with their QUALYs among other things, for as Ellis Boyd Redding (Morgan Freeman) said at his final parole hearing in "The Shawshank Redemption:
"So you go on and stamp your form, sonny, and stop wasting my time. Because to tell you the truth, I don't give a s**t.
@ Original Industry Insider
MS is a relapsing-remitting disease so the drugs may have done nothing for your sister. It may well have just been the course of the disease that kept her out of a wheel chair. Most studies of this seem to suggest that while the drugs can reach clinically irrelevant end points, they aren't particularly good at stopping progression of the disease.
But more to the point, how is it that the UK, Germany, France, Israel and other smaller countries are able to negotiate much better prices (67% lower according to the study) than the price in the US? Something is really broken with that model.
Are they advocating for biosimilars? If so, aside from Teva, would these biosimilaors produce the same quality of life parameters as the innovator drugs?
@ AnnePME
I haven't yet read the study itself, but from all the articles on it, I don't think they are advocating biosimilars.
They are simply asking why the drugs are 67% less expensive outside the US than in it, and raising questions about the marginal benefit shown by these drugs.
Edward, you presume to know more about my sister's course of MS than I, her brother, a physician. As it happens, she lived for 18 years with the disease, a peiod long enough such that her remissions could not have been solely ascribed to relapse or remission, or random chance alone.
Why don't you try restricting your comments to cases with which you have some personal familiarity. Other posters who know me on these boards know that I'm doing my best to keep from verbally whaling on you like I did that know-nothing Max.
I am new to this particular site, and to MS. Glad to see there is a place to air all sides and points of view. We(my husband & I) just went through some changes with insurance and my new neurologist(other one moved out of town). Anyways, I went through a few weeks without my Copaxone and did notice a difference. Not everyone knows what that is like, so I won't fuss about that one. But, the point about it being of help to someone will never be argued by me. I am inspired by the story of the sister living without needing a wheelchair. I hope to be as fortunate. The meds are costly, but in my opinion, worth it.
@Original Industry Insider "Why don’t you try restricting your comments to cases with which you have some personal familiarity."
Fair enough. But I did use the word "may," precisely because I have no way of knowing anything about your sister.
I know many people with MS, hundreds, including my spouse and don't know a single one who has not gotten worse over time in spite of the so-called disease modifying drugs.
When I read the studies of these drugs, it is very clear as someone else once said, the studies are about incomes not outcomes.
ah, Mr. Murray, I see you've met our resident blowhard. don't worry, there is no topic on which he is not an expert. please to see previous postings.
Thanks, Donna. What a novel concept! An actual patient with the disease we're talking about, who has benefitted from the drug! Perhaps this will allow the non-physician gas bags on this thread an opportunity to take a breather.
I think the volume of RCT data that is out there is far too large for there to be any question about whether these drugs reduce exacerbations in the short term. Clinical trials of drugs currently in development include an endpoint of disability progression, and these drugs are generally showing statistically and clinically significant efficacy against this endpoint, though none can remotely be called a cure.
Collecting the long term data is pretty difficult, as who wants to be assigned to placebo for 5 or more years when there are drugs available that have demonstrated some benefit?
Medical Marijuana may be a better choice of treatment for MS. "Just my opinion".
Great drug for pain and spasticity, though I'm not aware of any studies suggesting an impact on relapses or disability progression. Pot is probably a lot more fun than injecting yourself with an immunomdulator as well.
Biogen has an interesting oral drug which provided a 53% reduction in relapse rates and a 38% reduction in disability progression relative to placebo at 2 years in the first of two pivotal trials. New MRI-detectable brain lesions were reduced 85-90%. Sanofi has reported Phase 3 results for a once yearly infusion that reduced relapses 55% relative to the active control Rebif, which itself reduces relapses by about a third. Hopefully one of these will work out to provide significantly better options for patients, and more bang for the buck to the healthcare system.
Lisa, medical marijuana has been used successfully in MS to deal with pain and spasticity. Unfortunately the National MS Society does not support it. In fact the NMSS is way behind the curve when it comes to effective treatments for the sometimes disabling pain of the disease. If you are suffering from the pain of MS, I would suggest that you 1) do NOT rely solely on a standard neurologist for pain management, 2) get a good pain management specialist, 3( don't listen to those who will say that too much pain meds will turn you into an addict, and 4) don't turn to the National MS Society for any kind of advice whatsoever regarding pain-associated symptoms of MS.
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Drugs may not be cost effective, but they are often necessary no matter what.
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