Background Disease modifying therapies (DMT) for multiple sclerosis (MS) have a considerable economic impact on hospitals’ annual budgets. Since February 2017, there has been a shift of power from our Health Service Area to local MS committees to evaluate the appropriateness of DMT prescriptions.
Purpose To evaluate the benefits of including a pharmacist in the MS Committee in a third-level hospital.
Material and methods Descriptive, observational and retrospective study based on the information arising from the prescription of DMT for MS from February to August2016 vs February to August 2017. Patient and treatment data (prescriptions, previous DMT, costs) were retrieved from the Farmatools® management tool (outpatients clinical module).
The MS Committee organised weekly meetings with the neurologists in charge of monographic consultations for MS in our centre. The objective was to choose the most cost-effective alternative for those patients who were candidates to initiate or change their DMT. An evidence-based algorithm was designed to assist the Committee in decision-making.
Results Patients were classified regarding if they used home treatment: oral (dimethyl fumarate, teriflunomide, fingolimod) or injectable (interferon ß1A and 1B, glatiramer acetate), or infusion therapies (natalizumab and alemtuzumab). In 2016 215 patients received home treatment vs 243 in 2017, and the estimated annual cost per patient decreased by 10.5% (€10.428 vs €9.326). Despite the increase in patients being treated, the positive economic results were possible due to the prescription of more cost-effective alternatives for initial treatments such as interferon ß1B (2016, 0% vs 2017, 23%) and glatiramer (2016, 0% vs 2017, 13%) both considered as safe first-line treatments in MS. The same trends were observed in infusion therapies: 2016, 59 patients vs 2017, 61 patients, decrease of 12.5% in estimated annual cost per patient (€17.106 vs €14.962). In this case, this was explained by the administration of natalizumab using extended interval dosing (every 5 weeks).
Conclusion Including a pharmacist on the MS Committee has permitted the optimisation of the management of DMT in a Rational Use of Medicines context. Evidence-based clinical protocols are essential in order to contribute to the financial sustainability of public healthcare and to improve patient access to existing medicines.
No conflict of interest
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