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Cost-effectiveness of disease-modifying therapies in the management of multiple sclerosis for the medicare population
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Tappenden, P., McCabe, C., Chilcott, J., Simpson, E., Nixon, R., Madan, Jason, Fisk, J. D. and Brown, M. (2009) Cost-effectiveness of disease-modifying therapies in the management of multiple sclerosis for the medicare population. Value in Health, 12 (5). 657 -665. doi:10.1111/j.1524-4733.2008.00485.x
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Official URL: https://doi.org/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. © 2008, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Subjects: | R Medicine > R Medicine (General) | ||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Value in Health | ||||
| Publisher: | Elsevier Ltd | ||||
| Official Date: | 1 July 2009 | ||||
| Dates: |
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| Volume: | 12 | ||||
| Number: | 5 | ||||
| Page Range: | 657 -665 | ||||
| DOI: | 10.1111/j.1524-4733.2008.00485.x | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
| Date of first compliant deposit: | 19 July 2018 |
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