A budget impact analysis of natalizumab use in Ireland

Abstract

Multiple sclerosis is the commonest cause of disability in young Irish adults. Natalizumab reduces disability progression in those patients with relapsing remitting multiple sclerosis who are suitable for it. First line disease modifying therapies are given in the community and are paid for by the hi-tech drug scheme. Natalizumab is given in hospital and is paid for from the hospital's budget. Access to natalizumab has been problematic in some Irish hospitals. A budget impact analysis was performed to look at the overall cost to the Health Service Executive of giving natalizumab. A budget impact analysis was performed from the perspective of the Health Service Executive comparing the use of natalizumab with first line disease modifying therapies for 2009-2011. The study showed that currently, the use of natalizumab is likely to be cost saving to the Health Service Executive overall, because some of the costs for natalizumab are borne by private insurers, whereas, all of the costs of disease modifying therapies are borne by the Health Service Executive. Although the use of natalizumab is cost saving, current funding arrangements in the Health Service Executive do not allow for the transfer of money saved from drugs paid for in the hi-tech scheme, to hospitals who are supplying alternative treatments.