OBJECTIVE
To conduct a comparative assessment of public expenditures associated with the treatment of patients with four copies of the SMN2 gene using presymptomatic treatment strategies versus initiating therapy after symptom onset within the healthcare system of the Russian Federation.
MATERIAL AND METHODS
The study presents a mathematical model for cost assessment of initiating disease-modifying treatments including chronic treatments (risdiplam, nusinersen) or one-time gene replacement therapy (onasemnogene abeparvovec) before and after symptom onset in spinal muscular atrophy (SMA). It was assumed that early initiation of treatment reduces the risk of irreversible complications by 40 percentage points. In addition to medication costs, the model accounts for reduced needs for assistive devices, rehabilitation services, and indirect costs (loss of GDP due to decreased labor market participation of one parent providing care for a patient with complications). The analysis was conducted on a hypothetical cohort of newborns diagnosed with SMA and four copies of the SMN2 gene through newborn screening, over a 19-year time horizon, since currently, the «Circle of Kindness» Foundation provides treatment for SMA patients up to this age. The «Circle of Kindness» Foundation was established in 2021 to organize and finance medical assistance for children with severe life-threatening and chronic diseases, including rare (orphan) diseases. The founder of the Foundation, on behalf of the Russian Federation, is the Ministry of Health of the Russian Federation. The main source of funding for medical assistance provided by the «Circle of Kindness» Foundation is the increased personal income tax rate for individuals.
RESULTS
The annual cohort size of patients with four SMN2 copies diagnosed via newborn screening is estimated at 34 individuals. The presymptomatic treatment strategy is associated with cost savings in direct medical (disease progression-related) and indirect costs compared to therapy after symptom onset: 21.3 million RUB for nusinersen, 371.8 million RUB for risdiplam, and 1.106.6 million RUB for onasemnogene abeparvovec over the analysis horizon.
CONCLUSION
Presymptomatic SMA therapy in patients with four SMN2 copies diagnosed through newborn screening reduces the total treatment costs over a 19-year horizon.
