The economic impact of early high-efficacy therapy compared to a step-up approach in multiple sclerosis (MS) is significant and multifaceted, affecting both direct healthcare costs and broader societal expenses. Early high-efficacy therapy involves initiating potent disease-modifying treatments soon after diagnosis, aiming to aggressively control disease activity and prevent disability progression. In contrast, the step-up approach starts with less intensive therapies and escalates treatment only if the disease worsens.
Starting with early high-efficacy therapy generally leads to better clinical outcomes, which translates into substantial economic benefits over time. Patients receiving early aggressive treatment tend to experience fewer relapses, slower disability progression, and reduced hospitalizations. This reduces the need for acute care and costly interventions later in the disease course. Consequently, healthcare systems save money by avoiding expensive emergency treatments, frequent specialist visits, and long-term disability care. Moreover, early intervention can decrease the overall lifetime cost of MS management despite the initially higher drug costs associated with high-efficacy therapies.
In contrast, the step-up approach may appear less costly upfront because it begins with cheaper, lower-efficacy medications. However, this strategy often results in more relapses and faster accumulation of disability, which increases long-term healthcare utilization and indirect costs. Patients may require more frequent hospitalizations, rehabilitation, and eventually, assistance with daily living activities. These factors contribute to higher overall economic burdens, including increased out-of-pocket expenses for patients and greater strain on insurance and government healthcare programs.
Indirect costs are a crucial part of the economic picture. MS often leads to reduced work productivity, early retirement, and the need for home modifications or mobility aids. Early high-efficacy therapy, by preserving neurological function and delaying disability, helps maintain patients’ ability to work and reduces these indirect costs. Conversely, delayed or insufficient treatment can accelerate disability, increasing the likelihood of lost income and greater dependence on social support systems.
The evolving MS drug market also influences economic outcomes. The availability of biosimilars and generics is making high-efficacy treatments more affordable and accessible, which supports the case for early aggressive therapy from a cost perspective. Additionally, healthcare policies and insurance coverage improvements are reducing out-of-pocket expenses for patients, further encouraging early use of effective therapies.
In summary, while early high-efficacy therapy for MS involves higher initial medication costs, it leads to better health outcomes that reduce long-term healthcare spending and societal costs. The step-up approach, though less expensive initially, often results in greater cumulative costs due to increased relapses, disability progression, and associated indirect expenses. Therefore, from an economic standpoint, early high-efficacy treatment represents a more cost-effective strategy for managing MS over the patient’s lifetime.
