OBJECTIVES

The fiscal consequences of multiple sclerosis (MS) are broader than those observed within the healthcare system. As MS is a progressive debilitating disease, patients gradually experience reduced productivity and employment and require public benefits to maintain living standards. This study explores the value of public investments for two well-established disease-modifying therapies (DMTs) in MS from a fiscal perspective in Italy: delayed-release dimethyl-fumarate and natalizumab.

METHODS

Disease progression was simulated using a MS Markov model, over 30-years, for the DMTs dimethyl fumarate and natalizumab. A modified generational accounting modeling framework was employed that combined age-specific workforce participation rates and earnings, adjusted for EDSS scores, to quantify expected lifetime tax revenue from MS patients with and without DMTs. Social insurance costs by EDSS were also estimated to inform the broader fiscal costs associated with disease progression.

RESULTS

The analysis shows the total fiscal benefits of dimethyl fumarate and natalizumab offset 80% and 96% of the drug costs, respectively. Of the total benefits, direct medical costs, informal and community services constitute the majority of the total savings. Benefits resulting from both reduced social insurance expenditure and increased tax revenue represent 31.4% and 32.5% for dimethyl fumarate and natalizumab of the total fiscal benefits, respectively.

CONCLUSIONS

In addition to health service cost-offsets, DMTs result in increased tax revenues and social insurance cost-savings representing approximately 32% of the total fiscal benefits. The fiscal modeling framework described here shows a considerable offset of public investments in the DMTs that is not captured in classical cost-effectiveness or budget-impact analyses. Furthermore, it illustrates that a broader “government perspective” cost analysis reveals additional cost-savings that extend beyond the health service that can be used to inform allocation decisions as well as to support an appropriate level of funding for DMTs in Italy.