Graphical abstract
- •Costs for treating multiple sclerosis decreased by 0.4% per patient after the introduction of 2011 diagnostic criteria.
- •The highest slope change in annual costs per patient was in 2015 (10%), after the introduction of Alemtuzumab.
- •Disease modifying treatments remain the main responsible for increased medical direct costs in multiple sclerosis.
- •Improved diagnostic skills and patient profiling can mitigate costs for treating multiple sclerosis at patient level.
Abstract
Objective
To assess whether the introduction of the new diagnostic criteria and disease modifying
therapies (DMTs) is associated with higher cost for treating multiple sclerosis (MS).
Methods
This is a regression-based quasi-experimental study employing interrupted time series
analysis, including data from 2229 patients (age 42.1 ± 11.2 years; female 63.34%),
with incident diagnosis of relapsing remitting MS (RRMS) and followed up from 1997
to 2017, extracted from the database of the MS Clinical Care and Research Centre of
the Federico II University Hospital of Naples (Italy). Annual healthcare costs for
DMT (e.g., prescription, staff involved in DMT administration) and management (e.g.,
neurological consultations, other consultations related to DMT safety, MRI, laboratory
exams), were calculated and inflated to the most recent value.
Results
Annual costs per patient for DMT prescription and management were not affected by
the introduction of 2001 and 2005 criteria, but decreased by 0.4% after the introduction
of 2011 criteria (PD= -0.4%; 95% C.I. -0.7%/-0.0%; p = 0.023). Annual costs per patient increased by 11.2% after the introduction of Natalizumab
in 2007 (PD= 11.2%; 95% C.I.= 9.4%/13.0%; p <0.001), by 10.9% after the introduction of tablets in 2011 (Fingolimod, Teriflunomide
and Dimethyl Fumarate) (PD= 10.9%; 95% C.I. 9.2%/12.7%; p<0.001), and by 10.7% after the introduction of Alemtuzumab in 2015 (PD= 10.7%; 95%
C.I. 9.0%/12.4%; p< 0.001).
Discussion
DMTs remain the main responsible for increased medical direct costs in MS, whilst
improved diagnostic skills and subsequent patient profiling can at least in part mitigate
costs for MS treatment and management.
Keywords
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Article info
Publication history
Published online: November 09, 2019
Accepted:
November 8,
2019
Received in revised form:
October 8,
2019
Received:
April 23,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
