There is limited research regarding the overall costs of administering infusion disease-modifying drugs (DMDs) in patients with multiple sclerosis (MS).
The purpose of this study was to evaluate the real-world per-patient per-day costs of administering MS infusion DMDs.
Patients from the IQVIA™ RWD Adjudicated Claims–US database with a diagnosis of MS (ICD-9-CM/ICD-10-CM: 340.xx/G35) and ≥1 Healthcare Common Procedure Coding System (HCPCS) billed medical claims for an infusion DMD (natalizumab, alemtuzumab, or ocrelizumab) from 1/1/2017–9/30/2018 were identified. Inclusion criteria were age 18–65 years and ≥12 months pre-index eligibility (index=first infusion claim). Patients with infusion DMDs during <12-month pre-index, a DMD that was billed as National Drug Code (NDC) claim, or DMD costs or administration costs potentially out-of-range were excluded from analyses. Medical codes (ie, HCPCS, Current Procedural Terminology [CPT] and Revenue) billed on the same day as a HCPCS-coded infusion DMD claim were included. Medical codes were categorized as administration, co-administration (eg, pre-treatment steroid, antihistamine, pregnancy test, lab tests, etc), MS-related, potentially MS-related, and not MS-related. The primary outcome was the average non-DMD cost per patient by cost category and by DMD.
3236 patients treated with infusion DMDs were included in the study (natalizumab: 737 [22.8%]; ocrelizumab: 2207 [68.2%]; alemtuzumab: 292 [9.0%]). Mean total non-DMD costs for all medical codes billed on infusion-day were $1308 for alemtuzumab, $902 for ocrelizumab, and $597 for natalizumab. Costs for administration per patient were $1178 for alemtuzumab, $808 for ocrelizumab, and $468 for natalizumab. The next most costly categories were co-administration (alemtuzumab $93, ocrelizumab $63, natalizumab $54), MS-related (alemtuzumab $6, ocrelizumab $20, natalizumab $27), potentially MS-related (alemtuzumab $19, ocrelizumab $5, natalizumab $20), and unrelated (alemtuzumab $13, ocrelizumab $6, natalizumab $26). Costs billed on days other than the day of infusion administration were not included due to uncertainty regarding their relevance; therefore, cost estimates may be conservative.
Costs associated with administering infusion DMDs among patients with MS in the US should be considered in economic analyses. Challenges exist in setting rules for specificity and sensitivity (eg, time frame, code categorization, etc) for capturing appropriate costs.