title: Reconsidering the economic value of multiple sclerosis therapies.
abstract: OBJECTIVE
  To illustrate a more comprehensive view of value associated with medicines treating a highly severe illness and to apply these insights to estimate the costs and benefits of 3 treatments for multiple sclerosis (MS): Avonex, Tysabri, and Tecfidera.
  
  
  METHODS
  Retrospective study spanning 2002 to 2013. We used economic theory to derive the value of therapy to patients with MS and to individuals who face the risk of contracting MS in the future, under the alternative assumptions that therapies were fully insured or paid for out of pocket.
  
  
  METHODS
  Models were parameterized through secondary data analysis and targeted literature review. Estimates of individual value were aggregated to the societal level using therapy-specific treatment prevalence rates. Aggregate consumer value was compared with manufacturer revenue.
  
  
  RESULTS
  In the baseline model, Avonex, Tysabri, and Tecfidera generated $46.2 billion of total value to consumers, almost one-third of which accrued to those without MS. The total value to consumers was double manufacturer revenue. Results were qualitatively robust to the use of alternate epidemiological and economic parameters. We found that value to the healthy is positively related to disease severity, and that value to both the sick and the healthy are larger when costs are shared via health insurance.
  
  
  CONCLUSIONS
  Theory predicts that treatments for severe disease provide "peace of mind" value to the healthy. Avonex, Tysabri, and Tecfidera have generated significant social value, a large majority of which accrues to consumers. Future economic valuations of medical technology should consider both the potential value to the healthy and the effects of insurance.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Shih
authors.forename: Craig
authors.initials: C
authors.lastname: Wakeford
authors.forename: Dennis
authors.initials: D
authors.lastname: Meletiche
authors.affiliation: Precision Health Economics, 11100 Santa Monica Blvd, Ste 500, Los Angeles, CA 90025. E-mail: jesse.sussell@PHEconomics.com.
authors.forename: Jesse
authors.initials: J
authors.lastname: Sussell
authors.forename: Adrienne
authors.initials: A
authors.lastname: Chung
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Liu
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Shim
authors.forename: Darius
authors.initials: D
authors.lastname: Lakdawalla
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult