OBJECTIVES: To explore possible economic advantages associated to drug oral or subcutaneous administration in multiple sclerosis

METHODS: We studied the correlation between drug mode of administration (intravenous I.V., subcutaneous S.C., oral) and overall patient’s direct medical costs financed by the National Healthcare System (NHS). We used a specific multiple sclerosis (MS) patient questionnaire and had a number of 592 answers. Seven regressions have been performed and each regression has as dependent variable direct costs financed by NHS, overall (apart from drug costs) and by single cost category (hospitalizations, Day Hospital (DH)/outpatient visits etc.) and as independent variable the administration mode of the disease modifying treatment (DMT): S.C, I.V. and oral. Regressions have been controlled for independent variables other than administration mode which could have an impact on direct costs, such as demographic variables and disease severity.

RESULTS: Average direct cost of patients being treated with intravenous DMTs is 5,156€ per year (SD:5,493), of those treated with oral DMTs is 1,984€ per year (SD:2,747) and of those treated with subcutaneous DMTs is 2,026€ per year (SD:3,901). The difference is statistically significant (p<0,05 Kruskal Wallis test). Direct costs financed by the NHS are on average higher in patients treated with I.V. DMTs than those of patients taking S.C. or oral DMTs. Most impacted costs are DH/ outpatient costs (~3,900€ yearly/patient in I.V. patients, ~1,200€ in oral patients and 1,500€ in S.C. patients) and the difference is statistically significant. Drug administration mode, age, EDSS score and the presence of a caregiver have a statistically significant impact on total direct NHS costs (p-value lower than 0,05).

CONCLUSIONS: The analysis shows that different modes of administration of MS DMTs have a different impact on the healthcare expenditure and that oral and S.C. administration have a potential for savings for the healthcare expenditure.