Cost-Effectiveness of Disease-Modifying Therapies in the Management of Multiple Sclerosis for the Medicare Population

• Published in: Value in health 2009-07, Vol.12 (5), p.657-665
• Main Authors: Tappenden, Paul, MSc, McCabe, Christopher, PhD, Chilcott, Jim, MSc, Simpson, Emma, PhD, Nixon, Richard, PhD, Madan, Jason, MSc, Fisk, John D., PhD, Brown, Murray, PhD
• Format: Article
• Language: English
• Subjects: Beneficiaries; Cost effectiveness; Cost-Benefit Analysis; cost-utility analysis; Costs and Cost Analysis - economics; Costs and Cost Analysis - statistics & numerical data; decision analysis model; Discontinued; Drug Costs - statistics & numerical data; economic analysis; Glatiramer Acetate; Guidance; Humans; Immunosuppressive Agents - economics; Immunosuppressive Agents - therapeutic use; Interferon-beta - economics; Interferon-beta - therapeutic use; Internal Medicine; Medicare; Medicare - economics; Medicare - statistics & numerical data; Middle Aged; Models, Econometric; Multiple sclerosis; Multiple Sclerosis - drug therapy; Multiple Sclerosis - economics; Multiple Sclerosis - therapy; Nova Scotia; Peptides - economics; Peptides - therapeutic use; Quality-Adjusted Life Years; Treatment Outcome; United States; Withholding Treatment
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1111/j.1524-4733.2008.00485.x

Abstract Objective To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) for the management of multiple sclerosis (MS) compared to best supportive care in the United States. Methods Cost-effectiveness analysis was undertaken using a state transition model of disease natural history and the impact of DMTs for the representative Medicare beneficiary with MS. Costs and outcomes were evaluated from the health-care payer perspective using a 50-year time horizon. Natural history data were drawn from a longitudinal cohort study. The effectiveness of the DMTs was evaluated through a systematic review. Utility data were taken from a study of patients with clinically definite MS in Nova Scotia. Resource use and cost data were derived from the Sonya Slifka database and associated literature. Results When based on placebo-controlled evidence, the marginal cost-effectiveness of interferon beta (IFNβ) and glatiramer acetate compared to best supportive care is expected to be in excess of $100,000 per quality-adjusted life-year gained. When evidence from head-to-head trials is incorporated into the model, the cost-effectiveness of 6 MIU IFNβ-1a is expected to be considerably less favorable. Treatment discontinuation upon progression to Expanded Disability Status Scale 7.0 is expected to improve the cost-effectiveness of all DMTs. Conclusions Further research is required to examine the long-term clinical effectiveness and cost-effectiveness of these therapies. There is no definitive guidance in the United States concerning discontinuation of DMTs; this study suggests that the prudent use of a treatment discontinuation rule may considerably improve the cost-effectiveness of DMTs.