Evaluating Risks, Costs, and Benefits of New and Emerging Therapies to Optimize Outcomes in Multiple Sclerosis

BACKGROUND: Multiple sclerosis (MS) is a complex, chronic, and often disabling neurological disease. Despite the recent incorporation of new treatment approaches early in the disease course, care providers still face difficult decisions as to which therapy will lead to optimal outcomes and whento initiate or escalate therapies. Such decisions require proper assessment of relative risks, costs, and benefits of new and emerging therapies, as well as addressing challenges with adherence to achieve optimal management and outcomes.At the 24th Annual Meeting Expo of the Academy of Managed CarePharmacy (AMCP), held in San Francisco on April 18, 2012, a 4-hour activity titled “Analyzing and Applying the Evidence to Improve Cost-Benefit and Risk-Benefit Outcomes in Multiple Sclerosis” was conducted in associationwith AMCP’s Continuing Professional Education Partner Program (CPEPP).The practicum, led by the primary authors of this supplement, featured did actic presentations, a roundtable session, and an expert panel discussion detailing research evidence, ideas, and discussion topics central to MS and its applications to managed care. OBJECTIVES: To review (a) recent advances in MS management, (b) strategies to optimize the use of disease-modifying therapies for MS, (c) costs ofcurrent MS therapies, (d) strategies to promote adherence and compliance to disease-modifying therapies, and (e) potential strategies for managedcare organizations to improve care of their MS patient populations and optimize clinical and economic outcomes. SUMMARY: Advances in magnetic resonance imaging and newer therapies have allowed earlier diagnosis and reduction of relapses, reduction in progression of disability, and reduction in total cost of care in the long term.Yet, even with the incorporation of new disease-modifying therapies into the treatment arm a mentarium of MS, challenges remain for patients, providers,caregivers, and managed care organizations as they have to make informed decisions based on the properties, risks, costs, and benefits ofeach individual drug as part of an individualized shared decision-making process. Case management and collaborative practice models, which incorporate self-management, medication therapy, formulary management, and continuous education, while promoting symptom management, medication adherence, and a health-promoting lifestyle, are important in the overall management of MS and can provide outcomes-based interventions aimed at controlling costs while maximizing treatment efficacy.