OBJECTIVES

80% of Relapsing-Remitting Multiple Sclerosis cases in Chile utilizes outdated treatments, without access to other drugs unless their condition exacerbates, and disability appears; Despite evidence, the public payer has been rejecting coverage for cases dealing with contraindication of current therapies, and life-threating conditions have arisen. Patient-organizations and Specialists criticize lack of prevention of exacerbations and outdated local recommendation and coverage. We conducted a Cost-Study to identify direct costs of re-organizing the dispensation of current treatments and providing new drugs.

METHODS

We conducted a Cost-Study from the perspective of the public payer. Variables of Price, Quantity, and Expenditure were identified conducting: A literature review, Expert Validation Process, Clinical Pathways, and Pricing. After such, data for sub-groups, medical guidelines, case-mix, eligibility, costs-drivers and effective access to first (80%), second (20%) and third-line drugs (0%) was revealed. An evidence-based scenario analyzed the effect of changing those proportions to 0%, 72%, and 28% respectively, gaining early access to innovation-drugs, considering clinical features and coverage of alternatives for patients at death-risk.

RESULTS

According to specific disease-profile and equitable access to advanced medicines, a potential cost increase of 2.21 times compared to current scenario considering diagnosis, treatments, physical-therapy, and exacerbations, was estimated. Current cost in drugs is U$D6,897 per-case versus U$D19,769 in the simulation. For physical-therapy, current annual-cost is U$D599 versus U$D1,542 as expected (38,8% increase). The present cost of exacerbations is U$D1,893 compared to U$D312 in simulation. This is an 83,5% reduction attributable to early-access and reductions in hospital-based care.

CONCLUSIONS

Through a new reorganization of resources, the decrease of episodes of exacerbation, and availability of treatments for patients at death-risk can be projected. Chile is in urgent need to provide access in the public sector and at death-risk. By including innovative therapies earlier, exacerbations are diminished, cases are better managed, and resources can be better reallocated.