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

Garattini, Livio; Ghislandi, Francesca; Costa, Milene Rangel da

doi:10.1007/s40273-015-0322-7

Cited by 6 publications

(6 citation statements)

References 18 publications

(44 reference statements)

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“…The considerable use of newer DMTs (almost 40% of users) may explain the increase in day admissions seen in this study, as a result of drug administration for some of the newer treatments. It also contributes to the overall increase in DMT costs, highlighted also in other studies, 8,27,28 and representing about 75% of total costs for patients with mild disability.…”

Section: Discussionmentioning

confidence: 71%

New insights into the burden and costs of multiple sclerosis in Europe: Results for Italy

Battaglia

Kobelt²,

Ponzio

et al. 2017

Mult Scler

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Section: Discussionmentioning

confidence: 71%

New insights into the burden and costs of multiple sclerosis in Europe: Results for Italy

Battaglia

Kobelt²,

Ponzio

et al. 2017

Mult Scler

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“…Hawton and Green demonstrated that treatment expenditures are higher in patients who have outbreaks compared to patients who have not relapsed in the last six months, and expenditure increased substantially when relapses required hospital admission [ 20 ]. Most published cost effectiveness evaluations of the treatments for MS use long-term modeling; however, they typically use data from primary studies conducted for a short period only because of the paucity of studies performed over a long follow-up period][ 21 ].…”

Section: Introductionmentioning

confidence: 99%

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil

et al. 2018

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BackgroundMultiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions.Methods and findingsWe retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%.Results28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity).ConclusionsIn the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.

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“…The manual mentioned at the beginning 1 clearly stated that EE is most useful and appropriate when preceded by evidence of efficacy and/or effectiveness. Nevertheless, the literature is full of EEs [9][10][11] that are likely to add only: (1) further uncertainty when based on sophisticated long-term models populated by doubtful data; and (2) poor information when based on short-term 'decision trees' derived from heterogeneous and inconclusive clinical studies. In general, on the basis of clinical studies not adequately supported by rigorous methodology, EEs can only speculate on uncertainty and overemphasise economic results of uncertain pharmacological treatments.…”

Section: Efficacy/effectivenessmentioning

confidence: 99%

“…The volumes of all healthcare cost items estimated in an EE are rarely available from a single source and their collection often results in a piecemeal, patchy exercise, 11,27,28 with data extracted from a heterogeneous mix of more (e.g. clinical and administrative records) or less (e.g.…”

Section: Resource Consumptionmentioning

confidence: 99%

Dutch guidelines for economic evaluation: ‘from good to better’ in theory but further away from pharmaceuticals in practice?

Garattini

Padula

2017

J R Soc Med

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

Cited by 6 publications

References 18 publications

New insights into the burden and costs of multiple sclerosis in Europe: Results for Italy

New insights into the burden and costs of multiple sclerosis in Europe: Results for Italy

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil

Dutch guidelines for economic evaluation: ‘from good to better’ in theory but further away from pharmaceuticals in practice?

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