Background Relapsing remitting multiple sclerosis (RRMS) has an increasing incidence in young adults and a high social-economic impact. Treatment delays progression and does not cure the disease, but new oral drugs’ innovative pharmacodynamics profiles can improve the therapeutic approach. Therapy review could prompt a better understanding of RRMS care’s effectiveness.
Purpose To investigate the economic impact of RRMS therapy on the pharmacy of Macerata’s General Hospital from January 2011 to December 2014. To analyse patient demographics and clinical characteristics (ie, failures and adherence).
Material and methods This review was conducted in collaboration with RecordData srl (prescription data regional provider) and neurologists and nurses for analysis of failure reasons. Teamwork produced a database of patients’ therapeutic histories. We analysed prescriptions of: first generation disease modifying therapies (DMT) (interferon β-1a and β-1b, glatiramer); second generation DMT (fingolimod, natalizumab); and relapsing therapy (methylprednisolone). Dosage and administration frequency were compared with data from the Summary of Product Characteristics (SPC).
Results During the studied period, in a population of 118 patients treated (73 females; 45 males) with an average age of 39.8 years (range 16 to 63) and a mode of 32 years for both genders, 49 450 doses were prescribed (4086 packages: 21.9% in 2011; 24.72% in 2012; 25.48% in 2013; 27.9% in 2014) and 5 109 761.97€ spent (21.62% in 2011; 23.21% in 2012; 26.88% in 2013; 28.29% in 2014). Natalizumab, although only 1.62% of the provided doses (806/49 450), was the most expensive drug: 2 160 963.38€ (42.29%). Interferons represented 32.86% of costs with 38 154 doses (77.16%; -1.543 from 2011 to 2014) for 308 patients. From 2012, fingolimod was prescribed to 37 patients (10 304 doses; 20.84%) consisting of 12.48% of expenditure. Relapsing therapy concerned 83.1% of patients with 186 doses (0.37%) of methylprednisolone. Number of administrations was consistent with SPC data. Failures included 51 patients (43.22%): 17.65% interruptions (2 cases of adverse drug reactions); 42 (82.35%) switches (40.48% interferon-glatiramer; 28.57% interferon-fingolimod; 14.28% interferon-natalizumab).
Conclusion The review showed DMT high costs and complexity for RRMS management (interruptions/switches/relapsing). Teamwork is a priceless resource for patient healthcare. Monitoring is being extended through 2015, including teriflunomide, dimethyl-fumarate and alemtuzumab prescriptions.
References and/or Acknowledgements Summary of Product Characteristics.
No conflict of interest.
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