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Five Ways to Reduce MS Costs

CU School of Medicine

9/2/2016

AURORA, 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 journal Neurology. 

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.

 “We 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.”

 The five recommendations are: 

  • Avoid 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.

  • Customize 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.  

  • Develop 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 treatments.

  • Off-label 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.

  • Consider 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.

Corboy 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.

“Our 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.