Low use of new neurologic medications driven by relatively high cost

Despite the number of new medications produced to treat a range of neurologic diseases, limited utilization is driven by relatively high cost and similar efficacy to less expensive drugs, according to a study published in Neurology.

“Although the number of neurologist-prescribed medications and the cost of generic medications have largely remained stable, the cost increases have been driven by the high costs of multiple sclerosis medications and increasing costs of brand-name medications,” Evan L. Reynolds, PhD, of the department of neurology at the University of Michigan, and colleagues wrote.

Researchers aimed to compare costs and usage of newly released medications for neurologic conditions with older drugs supported by evidenced-based AAN guidance.

They compiled information from a health care pharmaceutical claims database from 2001 to 2019, to identify more than 2.5 million individuals with both a diagnosis of one of 11 neurologic conditions (orthostatic hypotension, spinal muscular atrophy, Duchenne’s disease, Parkinson’s disease, MS, ALS, myasthenia gravis, Huntington’s disease, tardive dyskinesia, transthyretin amyloidosis and migraine) and either a new or existing medication for that condition approved by the FDA between 2014 and 2018.

For each year, researchers calculated both out-of-pocket and standardized total costs for a 30-day supply of each medication, along with the proportion of individuals receiving these new drugs compared with all medications used for a specific condition.

Results showed limited use of newer medications (< 20% in all but one condition) compared with existing drugs. Utilization was highest for those with tardive dyskinesia (32.3%), Duchenne’s disease (19.8%), Huntington’s disease (19.5%) and transthyretin amyloidosis (17.3%), and smallest for those with PD who received monoamine oxidase-B inhibitors (2.9%) and patients with migraine (2.1%), orthostatic hypotension (1.8%) and MS (1.6%).

In addition, researchers reported out-of-pocket and standardized total costs were notably larger for newer medications, with costs for a 30-day supply in 2019 highest for edaravone ($712.80; range, $59.80 to $802), eculizumab ($91.10; range, $3 to $3,216.40) and valbenazine ($72; range, $18 to $518).

“For new, high-cost medications that have similar effectiveness to older drugs, limited use is likely appropriate,” Brian C. Callaghan, MD, MS, also of the department of neurology at the University of Michigan and co-author of the study, said in a related release. “Future studies are needed to look into whether the high costs are barriers to those new medications that can really make a difference for people living with neurologic disease.”

Reference:

• With high costs and similar benefits, use of new neurology drugs is low. https://www.aan.com/PressRoom/Home/PressRelease/5031. Published Nov. 30, 2022. Accessed Jan. 11, 2023.