Dennis N.Bourdette, Chair and Professor, Department of Neurology, Oregon Health & Science Universitybourdett@ohsu.edu
Submitted April 27, 2017
Dr. Otulana, Chief Medical Officer for Mallinckrodt Pharmaceuticals which produces H.P. Acthar Gel, claims that Acthar is cost effective in a response to our editorial. [1] To support this statement, Dr. Otulana references a study paid for by Mallinckrodt that is not a cost-effectiveness analysis. [2] The cited study compares costs of healthcare services delivered to patients that received Acthar compared with a group that received either plasmapheresis or intravenous immunoglobulins (IVIG) for multiple sclerosis (MS) relapse. [3] While there was a modest difference in total cost of care over 12 and 24 months after treatment between the two groups, the article by Gold et al. revealed that those receiving Acthar had much higher medication costs over 12 months compared with the plasmapheresis/IVIG group (mean of $87,200 vs $12,300). [2] The high medication costs may reflect the expense of Acthar. The current average acquisition price of a 5 mL vial of Acthar containing 80 IU/mL of repository corticotropin is $34,000. [3] Patients receive 80 IU of Acthar once a day for 5-15 days, [4] costing a stunning and unjustified $34,000-$102,000. I stand by our editorial in which we state that neurologists "...should not be using repository corticotropin to treat MS relapses given its high cost...." [1]
1. Bourdette D, Whitham R. Neurologists and the economics of MS treatment: Lighting candles, not cursing the darkness. Neurology 2016;87:1532-1533.
2. Gold LS, Suh K, Schepman PB, Damal K, Hansen RN. Healthcare Costs and Resource Utilization in Patients with Multiple Sclerosis Relapses Treated with H.P. Acthar Gel. Adv Ther 2016;33:1279-1292.
3. FDB MedKnowledge: Drug Pricing. In: First Databank [online]. Available at: www.fdbhealth.com. Accessed February 22, 2017.
4. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics 2013;10:97-105.
For disclosures, please contact the editorial office at journal@neurology.org.
Dr. Otulana, Chief Medical Officer for Mallinckrodt Pharmaceuticals which produces H.P. Acthar Gel, claims that Acthar is cost effective in a response to our editorial. [1] To support this statement, Dr. Otulana references a study paid for by Mallinckrodt that is not a cost-effectiveness analysis. [2] The cited study compares costs of healthcare services delivered to patients that received Acthar compared with a group that received either plasmapheresis or intravenous immunoglobulins (IVIG) for multiple sclerosis (MS) relapse. [3] While there was a modest difference in total cost of care over 12 and 24 months after treatment between the two groups, the article by Gold et al. revealed that those receiving Acthar had much higher medication costs over 12 months compared with the plasmapheresis/IVIG group (mean of $87,200 vs $12,300). [2] The high medication costs may reflect the expense of Acthar. The current average acquisition price of a 5 mL vial of Acthar containing 80 IU/mL of repository corticotropin is $34,000. [3] Patients receive 80 IU of Acthar once a day for 5-15 days, [4] costing a stunning and unjustified $34,000-$102,000. I stand by our editorial in which we state that neurologists "...should not be using repository corticotropin to treat MS relapses given its high cost...." [1]
1. Bourdette D, Whitham R. Neurologists and the economics of MS treatment: Lighting candles, not cursing the darkness. Neurology 2016;87:1532-1533.
2. Gold LS, Suh K, Schepman PB, Damal K, Hansen RN. Healthcare Costs and Resource Utilization in Patients with Multiple Sclerosis Relapses Treated with H.P. Acthar Gel. Adv Ther 2016;33:1279-1292.
3. FDB MedKnowledge: Drug Pricing. In: First Databank [online]. Available at: www.fdbhealth.com. Accessed February 22, 2017.
4. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics 2013;10:97-105.
For disclosures, please contact the editorial office at journal@neurology.org.