OBJECTIVES: To quantify resource utilization and costs associated with administration and monitoring of disease-modifying drugs (DMDs) in patients with relapsing multiple sclerosis (RMS) in the United States.

METHODS: Administration and monitoring resource use (eg, liver function tests, lymphocyte counts, infusion time) associated with oral, self-injectable, and infused DMDs for RMS was estimated from US product prescribing information and published literature, including the recently released American Academy of Neurology guideline. Cladribine Tablets resource use was estimated from the EU Summary of Product Characteristics. Resources were quantified over 4 years. Unit costs were based on the Medicare fee schedule. Costs of medications used for administration were based on the wholesale acquisition cost (WAC) as reported by Micromedex. Costs were adjusted to 2018 dollars as appropriate.

RESULTS: Four-year costs associated with administration and monitoring were nominal (<$650) for all injectable and all oral DMDs except fingolimod, where first-dose observation, especially if requiring an overnight hospital admission in a subset of patients, incurred a substantial cost (ie, four-year cost for fingolimod was $1,099). Four-year costs for infused DMDs ranged from $1,682-$9,444. Resources related to administering infusions were the most costly, including required premedication which represented a significant proportion of alemtuzumab’s costs. Tests for monitoring lymphocyte counts, liver, and thyroid abnormalities were the next most costly resources, and were highest during the first year of treatment.

CONCLUSIONS: Resources required for administration and monitoring of DMD treatment in patients with RMS are minimal for most therapies, but can be significant for DMDs requiring close observation or infusion. DMDs with fewer administration and monitoring requirements may result in decreased resource use and cost to the healthcare system.