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Cost of disease modifying therapies for multiple sclerosis: Is front-loading the answer?

  • Lisa Batcheller
    Correspondence
    Corresponding author at: Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, United Kingdom.
    Affiliations
    Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
    Search for articles by this author
  • David Baker
    Affiliations
    Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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      Highlights

      • There are now over a dozen DMTs available to treat MS.
      • The literature on the cost effectiveness of DMTs is often confusing and contradictory.
      • Currently, the drugs with the most benefit tend to be those that carry the most risk and highest price tag.
      • CEAs support the idea that using more aggressive measures earlier on may mean the cost of long term disability is reduced.

      Abstract

      There are now over a dozen disease modifying therapies (DMTs) available to treat multiple sclerosis (MS). They vary in efficacy and safety as well as in cost.
      The literature on the cost effectiveness of these is often confusing and contradictory. There is a lack of quality evidence enabling the comparison of different DMTs. There are scarce randomized controlled trials which look at one DMT compared with another that is not IFN or GA. There is also a lack of systematic reviews comparing the efficacy and safety of different DMTs. This makes it difficult to perform good quality cost-effectiveness analyses (CEAs). Furthermore, CEAs in and of themselves are difficult to interpret or compare due to the variation in methods and cost estimations as well as the use of outcome measures which cannot be proven over a reasonable timeframe.
      This review looks at the different DMTs available for MS and attempts to draw some conclusions on their cost-effectiveness. It also considers the costs and benefits of front loading the cost of treatment for MS by using more expensive and effective treatment earlier on.
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