Understanding Real-World Costs of Intravenous DMT for Multiple Sclerosis

Due to site-of-service shifts toward lower-cost infusion settings, the real-world average cost of ocrelizumab has decreased for payers over recent years, according to findings published in the Journal of Managed Care and Specialty Pharmacy.

Ocrelizumab is an anti-CD20 monoclonal antibody administered intravenously twice per year to treat patients with multiple sclerosis (MS). While ocrelizumab is an efficacious disease-modifying therapy (DMT), researchers said, limited data exists regarding its real-world utilization and costs.

Intravenous DMTs “are subject to site-of-service mark-ups by providers which lead to variability in the true cost to payers,” they said.

For their retrospective, repeated cross-sectional study, investigators used PharMetrics Plus to harness claims data from commercial US payers from January 1, 2018, to March 31, 2021. Costs were reported in 2020 US dollars and evaluated quarterly, overall, and by site-of-service.

Out of 46,269 claims, there were 23,389 (51%) ocrelizumab maintenance infusions administered in the office setting. Meanwhile, 18,906 (41%) infusions were administered in the hospital outpatient department, and 3974 (9%) took place in other sites-of-service.

Between Q1 2018 and Q1 2021, hospital outpatient department utilization decreased from 51% to 31%. Meanwhile, the number of claims in office and other settings rose from 42% to 59% and 7% to 10%, respectively.

The average overall cost of ocrelizumab infusions decreased from $44,085 to $36,602 over the study period. Of note, mean overall costs remained relatively unchanged in the office setting and other sites-of-service but decreased significantly in the hospital outpatient department, from $54,961 to $47,516. Median costs followed similar trends, according to the findings.

Researchers concluded the use of lower-cost settings and overall drop in hospital outpatient department costs drove the decrease in ocrelizumab expenses for payers.

“This demonstrated shift towards lower-cost infusion settings resulted in a downward trend in the real-world cost of [ocrelizumab] over time while still enabling payers to make well-informed patient-access decisions for MS therapies and supporting physician and patient choice,” investigators concluded.

Reference:
Pineda E, To T, Ng C, Bonine N. Trends in ocrelizumab cost and site-of-service among commercial payers in the United States. J Manag Care Spec Pharm. 2022;28(10-a suppl):S1-S137. doi:10.18553/jmcp.2022.28.10-a.s1