Colo. – A neurologist from the University of Colorado School of
Medicine and another from the NYU Langone Medical Center offer five ways for
patients with multiple sclerosis to reduce medical costs while enhancing the
quality of their care in an article published online Friday, Sept. 2, by the
article by Ilya Kister, MD, from NYU Langone, and John R. Corboy, MD, from CU,
outlines five recommendations for clinicians to take a greater role in shaping
clinical research agendas and helping establish cost-effective approaches.
have identified a number of possible therapeutic strategies that make medical
and economic sense,” said Corboy, who is professor of neurology at the CU
School of Medicine and co-director of the Rocky Mountain Multiple Sclerosis
Center at the University of Colorado. “While some of these strategies do not
yet have sufficiently high level of evidence, we advocate for high-quality
research that would put these approaches on a firm empiric basis.”
five recommendations are:
disease-modifying therapy for patients with ‘improbable MS’ – Misdiagnosed
cases of MS contribute to higher overall health care costs by prescribing
expensive therapies to those who do not benefit from them.
treatment of relapses – Relapses vary widely in severity, so treatment
should be tailored accordingly. For example, use of oral high dose
steroids may well be equivalent to intravenous steroids, with much reduced
cost. Plasma exchange may produce better long-term outcomes, but has been
studied only in severe relapses. Such customized treatment requires
additional trials to determine effectiveness.
alternative dosing strategies for FDA-approved MS disease-modifying
therapies – Effective therapies have been demonstrated in large randomized
trials, but more information is needed for dosing and scheduling of some
use of disease-modifying therapies for MS – There are some drugs where
evidence indicates potential benefit for patients with MS and which come
at a significantly lower price tag than the MS disease-modifying
therapies, currently about $60,000 per patient-year.
whether disease modifying therapies should be continued indefinitely – The
authors note that an answer to this recommendation cannot yet be
determined because there have been no prospective trials looking at
therapy discontinuation, and all clinical trials that led to federal approval
for disease-modifying therapies for relapsing MS had an age cut-off of 55
years or lower.
and Kister said the reason for assembling the recommendations is that the
rapidly increasing costs of therapies were being shifted to patients by insurers
and specialty pharmacies. In addition, other attempts to curtail costs were
calling for eliminating the use therapies with some patients without regard to
the nuances of their specific cases.
suggestions should not be viewed as practice guidelines, but as an effort to
set a patient-centered, neurologist-driven agenda for clinical research in MS
that would help improve outcomes and decrease costs,” write Corboy and Kister.