Presentation (CTI)

OBJECTIVES: In Romania, multiple sclerosis (MS) therapies, including self-administered treatments, are dispensed through 24 hospital-based MS centers under the national MS program, with uneven geographic distribution. Over 7,500 patients travel to these centers for reimbursed prescription renewal and drug collection, sometimes monthly, generating avoidable day-hospitalizations and substantial patient travel. Other national health programs (e.g., oncology, thalassemia) already operate mixed dispensing pathways, retaining hospital-based care only for initiation, monitoring, and complex cases while using retail pharmacies for prescription refills. This study analyzed real-world data to inform policy on transitioning eligible MS therapies to a dual dispensing model.
METHODS: We developed a cost-consequence model to compare current hospital dispensing with retail pharmacy dispensing over a one-year time horizon (2025 reference-year). Treatment costs, service tariffs and real-world data on treatment utilization and patient distribution informed payer (hospital services, outpatient care, drug costs) and patient (travel) outcomes. Two scenarios were assessed: (1) all retail-eligible self-administered therapies (cladribine, dimethyl fumarate, fingolimod, glatiramer acetate, interferon beta-1a, interferon beta-1b, ofatumumab, ozanimod, peginterferon beta-1a, siponimod, teriflunomide); and (2) monthly-prescription therapies only (dimethyl fumarate, ofatumumab, ozanimod).
RESULTS: Scenario 1 (78.6% of patients, covering all retail-eligible drugs) avoided ~20,200 costly MS-center day-hospitalizations, converted to lower-priced local ambulatory visits; this pathway shift was cost-saving for the payer, but retail vs. hospital drug prices drove a net incremental payer cost of ~EUR 0.11M; patient travel fell by ~3.3M km (~EUR 1.31M). Scenario 2 (14.8% coverage) avoided ~11,100 day-hospitalizations for net payer savings of ~EUR 0.16M; patient travel fell by ~1.8M km (~EUR 0.72M).
CONCLUSIONS: This model provides decision-support evidence on alternative MS drug dispensing pathways. Findings suggest rethinking dispensing may reduce avoidable MS-center visits and ease patient travel. Results are not prescriptive but intended to support informed dialogue among patients, clinicians, payers, and policymakers on optimizing MS care.