A new tool has been launched which models the true financial and workforce resources needed to safely provide disease-modifying therapies (DMTs) to people living with multiple sclerosis (MS). DMTs are an effective means of treating relapsing-remitting MS, the most common form of the condition, reducing the frequency of relapses and the build-up of lesions in the brain (Rice: 2014; Palace et al: 2015)*.

Over 20,000 people with MS are currently being treated with one of 11 different DMTs available around the UK, all of which come with an array of risks and side-effects. Tailored and specific monitoring of patients is therefore essential – but this labour-intensive element of treatment is currently neither planned for nor funded. Whilst NHS England has lately produced an algorithm to provide a national model for treatment**, this does not extend to monitoring.

The Neurology Academy is raising awareness of the time and cost of monitoring DMTs as part of a wider strategy to end MS service variance. A new modelling tool is now available in the resources section of the MS Academy’s website for healthcare professionals to assess the amount of time it takes to monitor patients receiving treatment and to understand the financial impact of that time.

Neuro-pharmacist Rachel Dorsey-Campbell, one of the tool developers, presented an initial national analysis at the recent ‘MS Service Provision in the UK; The Way Forward’ event. The data showed blood tests alone costing an excess of £350,000, whilst the cost in staff time could be as much as £1.2 million.

Rachel Dorsey-Campbell at ‘Service Provision in the UK; the Way Forward’, Birmingham November 2018

The tool uses 12 months of anonymised Blueteq data for published prescribing costs alongside modelling around numbers of blood tests and associated staff activity to calculate these projected costs, so the overall figures are an underestimate, given that Patient Access Schemes (PAS) apply to all the DMTs.

Sarah Gillett, Managing Director of the Neurology Academy said

‘The variation in services for people with MS is vast, and unpicking the true picture for this area of treatment is a huge step forward. We cannot address problems without really understanding them and this tool is just that – real insight and understanding. Now we can create solutions.’

Professor Gavin Giovannoni, Academic Director of MS Academy, said,

‘I was surprised that these costs were not captured by the NICE technology appraisals that primarily assess the drug costs in relation to NHS England. The costs of monitoring DMTs, which currently fall on NHS Trusts and CCGs, should really be included in costing models. Clearly, the burden of monitoring should be included in business cases when setting-up and running MS specialist services.’

Rather than mapping the current myriad models of monitoring, the Neurology Academy is interested in looking at alternative solutions which are less reliant on hospitals or community MS teams. As a next step, it is hoped that the tool will provide robust enough evidence, once validated, for inclusion in the MS Getting It Right First Time (GIRFT) programme.

 

Additional information

Endnotes

* Rice CM. Disease modification in multiple sclerosis: an update. Practical Neurology. 2014;14(1):6-13.
Palace J, Duddy M, Bregenzer T, Lawton M, Zhu F, Boggild M, et al. Effectiveness and cost-effectiveness of interferon beta and glatiramer acetate in the UK Multiple Sclerosis Risk Sharing Scheme at 6 years: a clinical cohort study with natural history comparator. The Lancet Neurology. 2015;14(5):497-505.

** NHS England: ‘Treatment Algorithm for Multiple Sclerosis Disease-modifying Therapies’ September 2018

  

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