Cost-Effectiveness Analyses in Multiple Sclerosis: A Review of Modelling Approaches

Abstract

The growing number of disease-modifying treatments (DMTs) for patients with multiple sclerosis (MS) and the high acquisition costs of these DMTs are likely to increase the demand for information on their cost effectiveness. To improve the comparability and applicability of the findings from future cost-effectiveness analyses, it would be useful to have a clear understanding of the methodological challenges of modelling the cost effectiveness of DMTs in MS and the different approaches taken by such studies to date. In contrast to previous review studies, this review focuses on long-term time horizon (≥10 years) simulation-based cost-effectiveness analyses with homogeneous contexts of analysis (i.e. those with similar study objectives, comparators, and target populations) published over the past decade. By doing so, it provides a clearer picture of how modelling approaches taken in the existing studies truly differ across studies, and reveals major areas for improvement in conducting future cost-effectiveness analyses of DMTs for patients with MS.

Cost-Effectiveness Modeling in Multiple Sclerosis: Playing Around with Non-Healthcare Costs?

“…Our review of the most recent economic evaluations conducted in the EU setting on first-generation DMDs confirms the widespread concern raised in previous wider reviews [6][7][8][9]. First, most studies were based on long-term modeling and they all had to rely on weak sources to populate them [8].…”

“…All these CoIs used the 'human capital approach' to assess indirect cost, a controversial method that is likely to lead to overestimates and implies a state of full employment in the long run [17], which is hardly the case in the EU countries in this period of unprecedented economic crisis. Last but not least, all the studies gave the clear impression of being part of the manufacturers' marketing strategies, trying to highlight high social costs for MS to demonstrate the value of their product [7][8][9].…”

“…Although medical evidence on the most dated DMDs is quite well established, the economic literature on these drugs is still controversial [6][7][8][9], casting doubts on their cost effectiveness. In this commentary, we assess the potential contribution of cost-effectiveness analyses to pricing and reimbursement decisions in Europe.…”

Clinical effectiveness and cost-effectiveness of beta-interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation

“…On the basis of title and abstract, 966 records were excluded and the remaining 57 records were included for full-text screening. A further 48 articles were excluded at the full-text stage, leaving nine systematic reviews, [245][246][247][248][249][250][251][252][253] of which eight were economic evaluation studies [245][246][247][248][249][250][251][252] and one was a systematic review of studies that used a generic tool to measure HRQoL in people with multiple sclerosis. 253 …”

“…We identified several related systematic reviews of cost-effectiveness evaluations in RRMS in the overview of systematic reviews. [245][246][247][248][249][250][251][252][253] Therefore, we performed searches for primary cost-effectiveness studies from the earliest search date found in these selected reviews (i.e. 2012) to April 2016.…”