Cost-effectiveness of injectable disease-modifying therapies for the treatment of relapsing forms of multiple sclerosis in Spain

Dembek, Carole; White, Leigh Ann; Quach, Jayson; Szkurhan, Andrea; Rashid, Nazia; Blasco, María Rosario

doi:10.1007/s10198-013-0478-z

Cited by 17 publications

(34 citation statements)

References 32 publications

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“…On the basis of title and abstract, 1168 records were excluded and the remaining 225 records were included for full-text screening. A further 213 articles were excluded at the full-text stage (see Appendix 7 for a list of excluded studies with reasons), leaving 10 studies 154,[264][265][266][267][268][269][270][271][272] that included a decision-analytic model used to estimate the cost-effectiveness of DMTs for treating people with RRMS. …”

Section: Results Of the Searches For Relapsing-remitting Multiple Sclmentioning

confidence: 99%

“…Dembek et al 270 Dembek et al 270 undertook a cost-effectiveness analysis to estimate the incremental costs and benefits of injectable DMTs in comparison with BSC in Spain. They compared three different regimens of IFN and GA.…”

Section: Imani and Golestani 269mentioning

confidence: 99%

“…All of the studies included an economic model to estimate the cost-effectiveness of DMTs for treating people with RRMS. The economic evaluations were mainly conducted in the USA 266,267,272 and Spain, 264,268,270 with two studies carried out in Iran 265,269 and the remaining studies carried out in the UK 154 and France. 271 Studies mainly compared IM IFN-β-1a once weekly, SC IFN-β-1a three times weekly, SC IFN-β-1b or SC GA with symptom management.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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

Melendez‐Torres

Auguste

Armoiry

et al. 2017

Health Technol Assess

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Background At the time of publication of the most recent National Institute for Health and Care Excellence (NICE) guidance [technology appraisal (TA) 32] in 2002 on beta-interferon (IFN-β) and glatiramer acetate (GA) for multiple sclerosis, there was insufficient evidence of their clinical effectiveness and cost-effectiveness. Objectives To undertake (1) systematic reviews of the clinical effectiveness and cost-effectiveness of IFN-β and GA in relapsing–remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) and clinically isolated syndrome (CIS) compared with best supportive care (BSC) and each other, investigating annualised relapse rate (ARR) and time to disability progression confirmed at 3 months and 6 months and (2) cost-effectiveness assessments of disease-modifying therapies (DMTs) for CIS and RRMS compared with BSC and each other. Review methods Searches were undertaken in January and February 2016 in databases including The Cochrane Library, MEDLINE and the Science Citation Index. We limited some database searches to specific start dates based on previous, relevant systematic reviews. Two reviewers screened titles and abstracts with recourse to a third when needed. The Cochrane tool and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Philips checklists were used for appraisal. Narrative synthesis and, when possible, random-effects meta-analysis and network meta-analysis (NMA) were performed. Cost-effectiveness analysis used published literature, findings from the Department of Health’s risk-sharing scheme (RSS) and expert opinion. A de novo economic model was built for CIS. The base case used updated RSS data, a NHS and Personal Social Services perspective, a 50-year time horizon, 2014/15 prices and a discount rate of 3.5%. Outcomes are reported as incremental cost-effectiveness ratios (ICERs). We undertook probabilistic sensitivity analysis. Results In total, 6420 publications were identified, of which 63 relating to 35 randomised controlled trials (RCTs) were included. In total, 86% had a high risk of bias. There was very little difference between drugs in reducing moderate or severe relapse rates in RRMS. All were beneficial compared with BSC, giving a pooled rate ratio of 0.65 [95% confidence interval (CI) 0.56 to 0.76] for ARR and a hazard ratio of 0.70 (95% CI, 0.55 to 0.87) for time to disability progression confirmed at 3 months. NMA suggested that 20 mg of GA given subcutaneously had the highest probability of being the best at reducing ARR. Three separate cost-effectiveness searches identified > 2500 publications, with 26 included studies informing the narrative synthesis and model inputs. In the base case using a modified RSS the mean incremental cost was £31,900 for pooled DMTs compared with BSC and the mean incremental quality-adjusted life-years (QALYs) were 0.943, giving an ICER of £33,800 per QALY gained for people with RRMS. In probabilistic sensitivity analysis the ICER was £34,000 per QALY gained. In sensitivity analysis, using the assessment group inputs gave an ICER of £12,800 per QALY gained for pooled DMTs compared with BSC. Pegylated IFN-β-1 (125 µg) was the most cost-effective option of the individual DMTs compared with BSC (ICER £7000 per QALY gained); GA (20 mg) was the most cost-effective treatment for CIS (ICER £16,500 per QALY gained). Limitations Although we built a de novo model for CIS that incorporated evidence from our systematic review of clinical effectiveness, our findings relied on a population diagnosed with CIS before implementation of the revised 2010 McDonald criteria. Conclusions DMTs were clinically effective for RRMS and CIS but cost-effective only for CIS. Both RCT evidence and RSS data are at high risk of bias. Research priorities include comparative studies with longer follow-up and systematic review and meta-synthesis of qualitative studies. Study registration This study is registered as PROSPERO CRD42016043278. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Results Of the Searches For Relapsing-remitting Multiple Sclmentioning

confidence: 99%

Section: Imani and Golestani 269mentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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

Melendez‐Torres

Auguste

Armoiry

et al. 2017

Health Technol Assess

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“…1 The seven studies finally selected [10][11][12][13][14][15][16] came from only four countries (Germany, Italy, Spain, and Sweden) ( Table 1); three focused on clinically isolated syndrome (CIS) 2 (comparing DMD vs. 'do nothing' or early vs. delayed regimens of the same DMD) and the other four on RRMS patients (comparing the two IFNbs and GA). Three studies included a cost-utility analysis, two a cost-effectiveness analysis, and the others both.…”

Section: Economic Evaluations In the European Unionmentioning

confidence: 99%

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

2015

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“…, using the utility index (QALY) to compare these two medicines, indicated that intramuscular Interferon beta1a (Avonex) was more cost -effective than subcutaneous Interferon beta -1 (Rebif) (21,24,28,45).…”

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confidence: 99%

Cost - effectiveness and Cost - utility of CinnoVex versus ReciGen in Patients with Relapsing - Remitting Multiple Sclerosis in Iran

et al. 2018

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Background: Multiple Sclerosis (MS) is a chronic and inflammatory disease that can affect the patients' quality of life and impose many costs on them. Several types of medicine are used to change the course of the disease, treat disease -related attacks, and treat the symptoms of multiple sclerosis. Objectives: The aim of this study was to determine and compare the cost-effectiveness and cost -utility of CinnoVex versus ReciGen as the first line treatment in patients with relapsing-remitting multiple sclerosis in Iran, Fars province, in 2016. Methods: This study was a cost -effectiveness and cost -utility study, in which a Markov model was used. A sample of 178 patients with MS was randomly selected. The costs were summed up from the societal perspective, and the study outcomes were QALY and the mean of relapse was avoided. To collect the required data, the cost data collection form, Kurtzke Expanded Disability Status Scale, and EQ -5D questionnaire were used. To analyze the data collected, the TreeAge Pro 2011 and Excel 2010 software were used as well. Results:The results showed that the mean cost for ReciGen and CinnoVex patients were 349.84 and 289.92 USD, respectively. In addition, the QALY means were 0.291 and 0.297 and the means of relapse avoided were 0.309 and 0.239 for ReciGen and CinnoVex patients, respectively. The one -way sensitivity analysis showed that the results of the model were sensitive to effectiveness and utility of both medicines, but had little sensitivity to other parameters. Conclusions: According to the results, ReciGen was more cost -effective in terms of relapse avoided and CinnoVex was more costeffective in terms of QALY. Therefore, ReciGen and CinnoVex can be the preferred options for physicians and for health policymakers and managers, respectively.

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Cost-effectiveness of injectable disease-modifying therapies for the treatment of relapsing forms of multiple sclerosis in Spain

Abstract: In our cost-effectiveness analysis of first-line injectable DMTs in Spain, we found IM IFNβ-1a to be more cost-effective than SC IFNβ-1a, IFNβ-1b or GA. Sensitivity analyses confirmed the robustness of these results.

Cited by 17 publications

References 32 publications

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

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

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

Cost - effectiveness and Cost - utility of CinnoVex versus ReciGen in Patients with Relapsing - Remitting Multiple Sclerosis in Iran

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