Purpose of Review

Multiple sclerosis (MS) is a prevalent and debilitating neuroinflammatory disease associated with a significant economic burden. Direct healthcare costs, which can average $70,000 a year, have risen rapidly over the last decade and are driven by the escalating cost of disease-modifying therapies (DMTs). Despite a growing number of DMTs, annual increases in price for most DMTs have commonly exceeded 10% over the last 15 years. The high cost of MS DMTs has created economic hardships for patients in terms of high out-of-pocket costs and insurance company-induced barriers. Although generic versions of glatiramer acetate and dimethyl fumarate have provided some lower cost options, the median annual price for branded products currently exceeds $90,000. The goal of this paper is to examine the economic landscape of MS DMTs in the USA.

Recent Findings

Recent economic analyses have provided new insights into the relative value of DMTs. Robust economic modeling studies suggest that costs per quality-adjusted life-year for most DMTs exceed commonly endorsed thresholds for what is considered a reasonable value in the USA. Because of higher efficacy and lower net costs, ocrelizumab and alemtuzumab are considered the best value. It is likely that generic versions of dimethyl fumarate and glatiramer acetate are also economically attractive.

Summary

DMTs provide clinical benefit for patients with MS; however, their high cost can be a financial burden and impede access. High DMT prices are the principal reason why cost-effectiveness studies have indicated the economic value of most DMTs is questionable.

中文翻译：

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美国多发性硬化症疾病改良疗法的经济学

审查目的

多发性硬化症（MS）是一种普遍且令人衰弱的神经炎性疾病，与巨大的经济负担相关。在过去十年中，直接的医疗费用平均每年为70,000美元，在疾病改变疗法（DMT）成本不断上涨的推动下迅速上升。尽管DMT数量不断增加，但在过去15年中，大多数DMT的价格年度涨幅通常超过10％。MS DMT的高成本为患者带来了经济困难，包括自付费用高以及保险公司造成的壁垒。尽管醋酸格拉替雷和富马酸二甲酯的通用版本提供了一些较低的成本选择，但品牌产品的年平均价格目前超过90,000美元。本文的目的是研究美国MS DMT的经济前景。

最近的发现

最近的经济分析为DMT的相对价值提供了新的见解。稳健的经济模型研究表明，大多数DMT的每质量调整生命年的成本超过了美国公认的合理值的普遍认可的阈值。由于更高的疗效和更低的净成本，ocrelizumab和alemtuzumab被认为是最佳价值。富马酸二甲酯和醋酸格拉替雷的通用形式在经济上也很有吸引力。

概括

DMT为MS患者提供临床益处；但是，它们的高成本可能会造成经济负担并阻碍获取。高DMT价格是成本效益研究表明大多数DMT的经济价值值得怀疑的主要原因。