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."
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