Cost Effectiveness of Oromucosal Cannabis-Based Medicine (Sativex®) for Spasticity in Multiple Sclerosis

Lu, Lanting; Pearce, H.; Roome, Chris; Shearer, James; Lang, Iain; Stein, Ken

doi:10.2165/11598470-000000000-00000

Cited by 19 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The observation that patient, caregiver and physician-reported efficacy was maintained over the 12-month period suggests that the maintenance of efficacy can be achieved at lower drug exposures that are seen in short-term clinical trials, and confirms previous observations that there is no evidence of tolerance with continuing use [10]. It also seems likely to have some implications for the pharmaco-economic evaluation of the cost-benefit of Sativex, which is generally based on a daily dose of eight sprays [32].…”

Section: Discussionsupporting

confidence: 78%

A Multicentre, Double-Blind, Randomised, Parallel-Group, Placebo-Controlled Study of Effect of Long-Term Sativex® Treatment on Cognition and Mood of Patients with Spasticity Due to Multiple Sclerosis

Vachová¹,

Novotná²,

Mareś³

2013

J Mult Scler

View full text Add to dashboard Cite

Objective: When Sativex  THC:CBD cannabinoid-based oromucosal spray was first approved as a prescription medicine for multiple sclerosis (MS) spasticity, there was some concern about its possible long-term impact on cognition and mood. The objective of this study was therefore to assess the long-term impact of Sativex on cognitive function and mood in MS patients with spasticity. Methods: 121 patients were randomly assigned Sativex or placebo in a double-blind manner. Patients selfadministered treatment daily for 48 weeks while maintaining anti-spasticity therapy. The primary endpoint was the difference between treatments in Paced Auditory Serial Addition Test (PASAT) score from baseline to end of treatment. Secondary measures included Beck Depression Inventory-II (BDI-II), Subject-, Physician-and Caregiver Global Impression of Change, and Columbia-Suicide Severity Rating Scale. Results: 62 patients were randomised to Sativex and 59 to placebo. There was no difference in the effect of Sativex on PASAT and BDI-II scores compared with placebo. Subject-, Physician-and Caregiver-rated improvements in spasticity with Sativex were all statistically significant. The mean daily dose of Sativex declined gradually to 6.4 sprays per day. Conclusion: Long-term treatment with Sativex was not associated with cognitive decline or significant changes in mood in this prone population sample. Sativex was efficacious and well tolerated across the study period and no new safety concerns were identified.

show abstract

Section: Discussionsupporting

confidence: 78%

A Multicentre, Double-Blind, Randomised, Parallel-Group, Placebo-Controlled Study of Effect of Long-Term Sativex® Treatment on Cognition and Mood of Patients with Spasticity Due to Multiple Sclerosis

Vachová¹,

Novotná²,

Mareś³

2013

J Mult Scler

View full text Add to dashboard Cite

show abstract

“…Moreover, cost-effectiveness analyses from Germany/Spain [28] and Italy [29] have shown that, compared with current standard-of-care treatment (physiotherapy and oral antispasticity medications) for patients with resistant MS-related spasticity, Sativex add-on therapy is a cost-effective option at commonly accepted willingness-to-pay thresholds. Although a similar cost-effectiveness analysis from the UK failed to replicate these results [30], differences in the way in which the Markov model was constructed (e.g., a higher mean dose of Sativex) might have contributed to a less favorable conclusion.…”

Section: Discussionmentioning

confidence: 95%

Effect of Sativex on spasticity-associated symptoms in patients with multiple sclerosis

Meuth

Vila

Dechant³

2015

Expert Review of Neurotherapeutics

View full text Add to dashboard Cite

Individuals with multiple sclerosis (MS) spasticity may experience a range of symptoms, such as bladder dysfunction, pain, impaired sleep quality and mobility restrictions that worsen as spasticity severity increases. In this review, the effects of Sativex(®) oromucosal spray on symptoms and functional impairment associated with MS-related spasticity were examined. Across Sativex studies, there was a clear trend for improvement in spasticity-associated symptoms that was more pronounced and sustained over time in Sativex responders. Meaningful symptomatic improvement was achieved within the recommended dosage limit of ≤12 sprays per day. In appropriate patients, Sativex has the potential to minimize the consequences of spasticity-related symptoms on quality of life and reduce the economic burden on healthcare systems.

show abstract

“…A publicly funded study in the United Kingdom found that nabiximols were not cost-effective at that threshold, while industry-funded studies built using Spain, Germany, Italy, and Wales as health marketplace settings found nabiximols to be cost-effective. 43–46…”

Section: Discussionmentioning

confidence: 99%

A Cost-Effectiveness Model for Adjunctive Smoked Cannabis in the Treatment of Chronic Neuropathic Pain

Tyree

Sarkar

Bellows

et al. 2019

Cannabis and Cannabinoid Research

View full text Add to dashboard Cite

Background: A recent meta-analysis affirmed the benefit of medicinal cannabis for chronic neuropathic pain, a disabling and difficult-to-treat condition. As medicinal cannabis use is becoming increasingly prevalent among Americans, an exploration of its economic feasibility is warranted. We present this cost-effectiveness analysis of adjunctive cannabis pharmacotherapy for chronic peripheral neuropathy. Materials and Methods: A published Markov model comparing conventional therapies for painful diabetic neuropathy was modified to include arms for augmenting first-line, second-line (if first-line failed), or third-line (if first- and second-line failed) therapies with smoked cannabis. Microsimulation of 1,000,000 patients compared the cost (2017 U.S. dollars) and effectiveness (quality-adjusted life years [QALYs]) of usual care with and without adjunctive cannabis using a composite of third-party and out-of-pocket costs. Model efficacy inputs for cannabis were adapted from clinical trial data. Adverse event rates were derived from a prospective study of cannabis for chronic noncancer pain and applied to probability inputs for conventional therapies. Cannabis cost was derived from retail market pricing. Parameter uncertainty was addressed with one-way and probabilistic sensitivity analysis. Results: Adding cannabis to first-line therapy was incrementally less effective and costlier than adding cannabis to second-line and third-line therapies. Third-line adjunctive cannabis was subject to extended dominance, that is, the second-line strategy was more effective with a more favorable incremental cost-effectiveness ratio of $48,594 per QALY gained, and therefore, third-line adjunctive cannabis was not as cost-effective. At a modest willingness-to-pay threshold of $100,000/QALY gained, second-line adjunctive cannabis was the strategy most likely to be cost-effective. Conclusion: As recently proposed willingness-to-pay thresholds for the United States health marketplace range from $110,000 to $300,000 per QALY, cannabis appears cost-effective when augmenting second-line treatment for painful neuropathy. Further research is warranted to explore the long-term benefit of smoked cannabis and standardization of its dosing for chronic neuropathic pain.

show abstract

Cost Effectiveness of Oromucosal Cannabis-Based Medicine (Sativex®) for Spasticity in Multiple Sclerosis

Cited by 19 publications

References 14 publications

A Multicentre, Double-Blind, Randomised, Parallel-Group, Placebo-Controlled Study of Effect of Long-Term Sativex® Treatment on Cognition and Mood of Patients with Spasticity Due to Multiple Sclerosis

A Multicentre, Double-Blind, Randomised, Parallel-Group, Placebo-Controlled Study of Effect of Long-Term Sativex® Treatment on Cognition and Mood of Patients with Spasticity Due to Multiple Sclerosis

Effect of Sativex on spasticity-associated symptoms in patients with multiple sclerosis

A Cost-Effectiveness Model for Adjunctive Smoked Cannabis in the Treatment of Chronic Neuropathic Pain

Contact Info

Product

Resources

About