July 20, 2011 -- Drugs that slow progression of multiple sclerosis (MS) offer health gains to some at very high prices, a new study shows.
The study seems likely to reignite the national debate about how best to rein in runaway health care costs. It found that adding an injectable disease-modifying drug to the treatment of MS patients roughly doubles the cost of care, while only providing small population-level improvements in survival and quality of life.
Doctors who were not involved in the study were alarmed by its findings.
"We know, unequivocally, that these drugs slow the progression of the disease and slow the course of the disease," says Karen Blitz-Shabbir, MD, director of multiple sclerosis care center at North Shore-LIJ Glen Cove Hospital in New York.
"When I first started training, people were hospitalized all the time and did much worse than they do now," she says, "So we know for sure these drugs are good."
But the cost of the drugs continues to soar.
Even in the face of new competition from a new pill, pharmaceutical companies recently announced increases of nearly 40% over 2010 prices. Disease-modifying drugs for MS carry wholesale prices of as much as $48,000 a year.
"Will the health care companies, the health care industry, prevent patients from accessing the drugs because of a study like this?" Blitz-Shabbir says. "The real problem is the pharmaceutical cost is out of control."
Using mathematical models developed using data from a large, national patient survey, researchers found that the cost-effectiveness for the disease-modifying drugs Avonex, Betaseron, Copaxone, and Rebif exceeded $800,000 per quality-adjusted life year.
A quality-adjusted life year is a measure that tries to account for both the length of time a person could expect a treatment to extend life and how good he or she feels during that time.
For example, the study found that on average, patients taking Copaxone for 10 years could expect the drug to add less than one quality-adjusted month to their lives compared to patients who were only getting supportive therapy to control symptoms.
Patients taking Avonex, Betaseron, and Rebif gained about two quality-adjusted months compared to those getting supportive care.
The study also looked at how likely the drugs were to prevent relapses.
Those taking disease-modifying drugs spent on average nearly six out of 10 years with no relapses, compared to five years with no relapses for those who did not take disease-modifying drugs.
However, the effectiveness varied significantly among individuals, with some experiencing double the improvements and being able to live independently and prolong their employment and others not getting any meaningful effect.
Why Cost-Effectiveness Matters
"We were surprised how non-cost-effective they are," says study researcher Katia Noyes, PhD, MPH, assistant professor of health services research at the University of Rochester, N.Y.