番茄社区

NATIONAL HARBOR, Md. -- Although they are expensive, disease-modifying therapies may drive down other healthcare costs, according to posters presented here.

In one analysis, total health expenditures rose after patients started on these drugs, but medical costs unrelated to the drugs fell, , of Ohio Health, and colleagues reported at the here.

In another, interferon beta-1a was associated with lower overall medical costs compared with several oral drugs, according to , of EMD Serono, although outside experts noted several caveats with the analysis.

Disease-modifying therapies have changed the management of patients with multiple sclerosis, but there's little evidence on how the drugs impact the overall cost of care -- beyond being expensive themselves. MS clinicians told 番茄社区 that the exact prices of the drugs are hard to get a handle on, given differences driven by co-pays, coupons, patient assistance programs, and other incentives.

Both posters, however, offer an estimate of the costs associated with those drugs.

Boster and colleagues looked at claims data from Truven's MarketScan database on 3,081 patients who started a disease-modifying therapy in 2013, and compared them with costs from the previous year, when they weren't on the drugs.

In their study -- which was supported by Biogen -- they found that overall medical costs rose significantly in that first year, being lowest for those who started on Biogen's drug dimethyl fumarate (Tecfidera) and highest for those on fingolimod (Gilenya):

• Dimethyl fumarate: $60,465
• Interferon beta: $61,765
• Glatiramer acetate: $63,205
• Teriflunomide: $63,267
• Fingolimod: $77,167

They also attempted to estimate the costs associated with the drugs alone for that first year:

• Teriflunomide: $41,848
• Dimethyl fumarate: $45,000
• Glatiramer acetate: $46,318
• Interferon beta: $46,916
• Fingolimod: $57,400

They concluded that nonprescription medical costs fell for all patients who started on a drug, with the biggest savings for those on dimethyl fumarate:

• Dimethyl fumarate: $6,747
• Fingolimod: $4,246
• Interferon beta: $2,746
• Glatiramer acetate: $1,453
• Teriflunomide: $581

Those reductions were driven by cost decreases for outpatient services and hospitalizations, the researchers said.

The study supported by EMD Serono, which makes interferon beta-1a (Rebif), looked at claims data from IMS Health on 1,665 patients who started on one of four disease-modifying therapies -- interferon beta, dimethyl fumarate, fingolimod, or teriflunomide -- from Jan. 1, 2012 to June 30, 2013.

They used least-square means to determine total healthcare costs for the first year after starting therapy, which were lowest with teriflunomide:

• Teriflunomide: $55,414
• Interferon beta: $57,558
• Fingolimod: $69,478
• Dimethyl fumarate: $69,798

They found that total healthcare expenditures without disease-modifying drugs, however, were significantly lower with interferon compared with all three other drugs:

• Interferon: $13,562
• Fingolimod: $15,840 (P=0.02)
• Teriflunomide: $17,148 (P=0.03)
• Dimethyl fumarate: $20,987 (P<0.0001)

Phillips told 番茄社区 that her team didn't look at the factors that were driving these cost differences, but that it's "important to look at real-world data and what is going on within patient care, outside of a clinical trial setting."

, a biostatistics expert from the University of Alabama, who wasn't involved with the studies, told 番茄社区 that there were several caveats with both posters. Patients are more likely to have side effects the first year that they're on a drug, so the costs may be increased, and so a longer follow-up would be needed.

Also, younger patients whose disease is less active may be more likely to go on certain drugs, which could also be driving differences in costs.

In terms of helping to get a better handle on how much these medications cost, Cutter said the studies are just estimates that are made useful for comparisons, but are not necessarily reflective of true costs: "They could be off by $10,000 in terms of what the actual costs are," he said of the study that relied on least squared means.

"The Europeans and Canadians can do much better analyses of their systems" when it comes to cost, Cutter said. "The problem here is that nobody wants us to know the drug price.