Improving quality, affordability, and equity of multiple sclerosis care

Area of Science:

• Neurology
• Health Economics
• Pharmacology

Background:

• Current multiple sclerosis (MS) treatment selection leads to rising healthcare costs without proven outcome improvements.
• Lack of guidance exists on balancing the benefits, risks, and costs of highly effective disease-modifying therapies (DMTs).

Purpose of the Study:

• To develop a standardized, ethical, and cost-sensitive algorithm for selecting MS DMTs.
• The goal is to enhance the quality, affordability, and equity of care for individuals with MS.

Main Methods:

• MS experts and health plan pharmacists collaborated to create a risk-stratified treatment algorithm.
• Patients were classified into high, intermediate, or low disability risk groups based on evidence and consensus.
• DMTs were categorized by effectiveness and safety, with lower-cost options prioritized when efficacy and safety were comparable.

Main Results:

• A risk-stratified approach guides the early use of highly effective DMTs (HETs) for high-risk patients.
• Affordable induction therapy options were incorporated for intermediate/low-risk patients facing cost or access barriers.
• Preferred HETs include rituximab and natalizumab; preferred moderately effective agents include interferon-betas or glatiramer acetate.

Conclusions:

• The recommended approach offers clear guidance on prescribing HETs and prioritizing lower-cost DMTs.
• The algorithm can accommodate patients with cost or access barriers and is adaptable to different healthcare settings.
• Physician groups and health plans should collaborate to implement this strategy, with further research needed on prognostic risk factors.