Evaluating the Rational Use of Disease Modifying Therapies for Relapsing Remitting Multiple Sclerosis Using Claims Data
Author(s)
Xiang Wang, BS, MA1, Feili Zhao, PharmD, PhD2, Shu Chuen Li, PharmD, PhD3.
1University of Newcastle, Castle Hill, Australia, 2Beijing Health Economics Association, Beijing, China, 3University of Newcastle, Callaghan, Australia.
1University of Newcastle, Castle Hill, Australia, 2Beijing Health Economics Association, Beijing, China, 3University of Newcastle, Callaghan, Australia.
OBJECTIVES: To evaluate trends in the utilisation, cost, and switching patterns of Disease-Modifying Treatments (DMTs) for Relapsing-Remitting Multiple Sclerosis (RRMS) under the Pharmaceutical Benefits Scheme (PBS) in Australia from 2010 to 2021.
METHODS: This retrospective analysis included 14 DMTs available on the PBS for RRMS during the study period. Data on patient demographics, treatment uptake, switching patterns, and direct drug costs were analysed. Trends in Defined Daily Doses (DDDs), persistence, and administration routes were also assessed.
RESULTS: The cohort included 2,315 RRMS patients initiating DMTs between 2010 and 2021 (73% female; mean age 41.93 years). The number of patients on DMTs increased fivefold, and DMT expenditures rose 4.5-fold (AUD 109.4M to AUD 492.9M), with a compound annual growth rate of 13.6%, significantly outpacing overall PBS expenditure growth. High-efficacy (HE) DMTs gradually replaced low-efficacy (LE) therapies, with HE drugs accounting for most treatment switches (36.91% from LE to HE; 32.77% within HE). Persistence was higher for HE DMTs (median 25.49 months) compared to LE DMTs (20.80 months). Oral DMTs initially replaced injectables following the introduction of fingolimod in 2011, but since 2017, long-acting infusion therapies like ocrelizumab have gained market dominance. Direct drug costs varied, with HE DMTs generally being more expensive. Cladribine had the highest annual per-patient cost (AUD 49,308.58), while interferon beta-1a had the highest cost among LE DMTs due to elevated annual DDDs.
CONCLUSIONS: The study highlights a clear transition towards HE DMTs, reflecting evolving clinical practices and preferences for more effective treatments. These shifts, alongside with the higher cost associated with HE therapies, underscore the growing financial impact of RRMS management on the PBS and the importance of cost-effective strategies for optimising treatment access and outcomes.
METHODS: This retrospective analysis included 14 DMTs available on the PBS for RRMS during the study period. Data on patient demographics, treatment uptake, switching patterns, and direct drug costs were analysed. Trends in Defined Daily Doses (DDDs), persistence, and administration routes were also assessed.
RESULTS: The cohort included 2,315 RRMS patients initiating DMTs between 2010 and 2021 (73% female; mean age 41.93 years). The number of patients on DMTs increased fivefold, and DMT expenditures rose 4.5-fold (AUD 109.4M to AUD 492.9M), with a compound annual growth rate of 13.6%, significantly outpacing overall PBS expenditure growth. High-efficacy (HE) DMTs gradually replaced low-efficacy (LE) therapies, with HE drugs accounting for most treatment switches (36.91% from LE to HE; 32.77% within HE). Persistence was higher for HE DMTs (median 25.49 months) compared to LE DMTs (20.80 months). Oral DMTs initially replaced injectables following the introduction of fingolimod in 2011, but since 2017, long-acting infusion therapies like ocrelizumab have gained market dominance. Direct drug costs varied, with HE DMTs generally being more expensive. Cladribine had the highest annual per-patient cost (AUD 49,308.58), while interferon beta-1a had the highest cost among LE DMTs due to elevated annual DDDs.
CONCLUSIONS: The study highlights a clear transition towards HE DMTs, reflecting evolving clinical practices and preferences for more effective treatments. These shifts, alongside with the higher cost associated with HE therapies, underscore the growing financial impact of RRMS management on the PBS and the importance of cost-effective strategies for optimising treatment access and outcomes.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD290
Topic Subcategory
Health & Insurance Records Systems
Disease
STA: Multiple/Other Specialized Treatments