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Supplements Cost-Effectiveness of Disease- Modifying Therapies in Multiple Sclerosis: A Managed Care Perspective
Overview and Diagnosis of Multiple Sclerosis
Samuel F. Hunter, MD, PhD
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Economic Burden of Multiple Sclerosis and the Role of Managed Care Organizations in Multiple Sclerosis Management
Gary M. Owens, MD
Cost-Effectiveness of Disease- Modifying Therapies in Multiple Sclerosis: A Managed Care Perspective
Cost-Effectiveness of Disease-Modifying Therapies in Multiple Sclerosis: A Managed Care Perspective

Economic Burden of Multiple Sclerosis and the Role of Managed Care Organizations in Multiple Sclerosis Management

Gary M. Owens, MD
      Overall absenteeism can be high for patients with MS who continue working. Data demonstrated that absenteeism rates for employees with MS ranged from 2.98 to 8.13 days annually. Moreover, their total sick time ranged from 7.33 to 20.67 days, with associated sick-leave costs ranging from $523 to $1431 over a 1-year period.38,40 Realistically, the proportion of patients with MS in any
risk-adjusted total annual medical costs for those taking DMTs was $4393 versus $6187 for those who were not treated. Indirect costs were also significantly lower for employees with at least 1 DMT claim compared with untreated workers: $2252 versus $3053 annually, respectively.18,42 DMTs may have a positive impact on employment and work productivity; however, benefits specific to particular DMTs are not conclusive at this time.18

      
The economic burden of MS also extends beyond affected patients and the workplace. Because of limitations related to their disease and associated functional and cognitive impairments, patients with MS  often require substantial help from caregivers, including spouses and relatives, to perform daily tasks. Data have shown that the stress and physical burden of caring for a patient with MS can substantially impact the health of caregivers, even increasing their own requirements for, and use of, healthcare resources.38 Data from a US study showed that 53% of informal caregivers missed an average 7.3 days of work over a period of 1 year due to their responsibilities as a caregiver for a patient with MS. Of these caregivers, 7% reported changing their own employment to accommodate their role in caring for the patient. Also, 28% reported hypertension, 26% reported high cholesterol, 13% reported chronic headaches, 13% reported persistent sleep abnormalities, and 17% reported depression or anxiety.38 Even from the earliest stages of disease, MS not only has a profound impact on affected patients, but employers, families, and society in general, limiting productivity and creating substantial financial burden for all involved.38

The Role of Managed Care Organizations in MS Management
       To provide optimal patient management, managed care professionals must take into account that MS and its symptoms are associated with numerous and significant personal, professional, and economic burdens. Because of its early age of onset, the disease requires lifelong, complex, dynamic treatments, creating a substantial economic burden on patients with MS, their families and caregivers, healthcare systems, and society. Costs associated with providing benefits for MS therapy and management are rising continuously, and the increasing complexity of the MS therapy market is making a remarkable impact on disease management and those providing this care.
      The cost of providing health plan benefits and insurance coverage for MS therapy is one of the most rapidly growing segments of current healthcare expenditures. Evolving drug complexity portends increasing complexity for payers and health plans. Therefore, improved action plans must be developed that balance appropriate access to optimal therapies with the need to manage the high
costs of DMTs and evolving treatments. Overall, there is a need for better individualized management of patients with MS using evidence-based guideline recommendations as the basis for therapy, including initial treatments, drug switches, and the use of combination therapy.28
      Shared decision making is now a vital component within all areas of medical practice. Decisions about MS management are highly complex, and shared decision making between healthcare providers and patients must be improved to increase collaboration and optimize the overall management of MS. Payers need to take into account the impact of their access and coverage policies
for MS drugs on individual patients. Healthcare providers and payers must work better together to assess new and emerging treatments because “one-size-fits-all” therapy cannot be rigidly applied to all patients with the disease. Variations in disease type and severity, and patient preferences for treatment should be taken into consideration to truly build collaborative and optimal strategies for disease management that address all aspects of therapy and balance efficacy and cost.43
      
Future research and the application of prognostic indicators and treatment biomarkers may further refine future clinical algorithms for therapy and patient management. In addition, additional comparative studies to differentiate newer and emerging treatments can help determine which drugs might work best for particular patients with MS, and under which circumstances they will function
most effectively, leading to better overall treatment efficacy, safety, patient use, and cost savings. Managed care organizations need to continuously evolve with these treatments and strategies to promote optimal use of therapeutics and improve patient outcomes. This evolution will maximize cost savings and decrease the clinical and economic burdens of MS for patients, caregivers, employers, the entire healthcare system, and society.28


Conclusion

      
The management of MS has become increasingly complex and more costly over the past several years, which is primarily related to the development and approval of new DMTs that, although well tolerated and effective, come with considerably higher costs. Managed care clinicians and providers should enable patients with MS to receive the most effective therapies while maximizing the value of these agents and achieving a reasonable balance between therapy efficacy and expense. More than ever, the management of MS must be individualized, and patients and their healthcare providers must work together to make decisions surrounding what treatments to use, and how to best manage each patient’s disease. Only through consistent collaboration and shared decision making will patients, providers, and payers ensure that therapies are chosen appropriately and used optimally to help relieve the clinical and economic burdens of MS and improve patient outcomes as much as possible.

Author affiliation: Gary Owens Associates, Ocean View, DE.
Funding source: This activity is supported by educational grants from Novartis Pharmaceuticals Corporation and Genzyme, a Sanofi Company.
Author disclosure: Dr Owens reports receipt of honoraria from, and serving as a consultant for, Biogen, Genentech/Roche, Genzyme, and Novartis.
Authorship information: Concept and design; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and supervision.
Address correspondence to: gowens99@comcast.net.
 
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