Table 1.
Estimated global distribution of MS where per capita gross national income is less than the annual cost of expensive DMT and the cost of MS-DMT.
| (a) Countries | Annual income (US$) | Number of pwMS | Prevalence/100,000 |
|---|---|---|---|
| Africa | |||
| South Africa | 6080 | 3500 | 5 |
| Kenya | 1340 | 400 | 1 |
| Libya | 380 | 350 | 5.9 |
| Middle East/North Africa | |||
| Algeria | 4180 | 7000 | 20 |
| Morocco | 3030 | 700 | 20 |
| Jordan | 4689 | 2500 | 39 |
| Europe | |||
| Turkey | 9950 | 40,000 | 55 |
| Hungary | 12,970 | 20,000 | 62 |
| Romania | 9510 | 6000 | 30 |
| Latin America | |||
| Brazil | 9990 | 30,000 | 15 |
| Mexico | 9710 | 15,000 | 15 |
| Argentina | 12,450 | 8000 | 18 |
| Asia | |||
| India | 1590 | 85,000 | 7 |
| China | 7900 | 20,000 | 1.5 |
| Sri Lanka | 3800 | 1000 | 4.9 |
|
(b) Drug name |
Brand name |
Illustrative UK price ($) |
Illustrative US Price ($) |
| Cyclophosphamidea | Cytoxan | 332 | 6754 |
| Low efficacy | |||
| IFNβ-1a | Rebif | 14,683 | 91,307 |
| IFNβ-1a | Avonex | 11,808 | 85,167 |
| IFNβ-1b | Betaferon | 10,163 | 89,133 |
| Glatiramer acetate | Copaxone | 9305 | 89,131 |
| Teriflunomide | Aubagio | 18,790 | 88,721 |
| Azathioprinea | Imuran | 150 | 714 |
| Moderate efficacy | |||
| Dimethyl fumarate | Tecfidera | 24,858 | 92,378 |
| Fingolimod | Gilenya | 26,615 | 98,536 |
| High efficacy | |||
| Natalizumab | Tysabri | 20,403 | 83,986 |
| Alemtuzumab | Lemtrada | 39,138b | 91,072b |
| Oral cladribine | Mavenclad | 39,807 | Not available |
| Cladribinea | Leustatin | 1330 | 1815 |
| Mitoxantronea | Novantrone | 429 | 908 |
| Rituximaba | Mabthera | 4851 | 3807 |
(a) The estimated global distribution of MS in the top three countries in each continent and annual income in each region. The figures were based on the Atlas of MS and the World Bank Report. (b) Price of MS-DMT for 70 kg individual based on UK cost and the US pharmacy over-the-counter cost ($US. www.drugs.com, accessed March 2018).
aOff-label use.
bAverage annual cost from two treatment cycles. UK/US prices converted as US$1 = £0.72 March 2018.
MS: multiple sclerosis; DMT: disease-modifying treatment; IFNβ: interferon beta; pwMS: people with multiple sclerosis; UK: United Kingdom; US: United States.