Perspectives for Managed Care Organizations on the Burden of Multiple Sclerosis and the Cost-Benefits of Disease-Modifying Therapies

Owens, Gary M.; Olvey, Eleanor L.; Skrepnek, Grant H.; Pill, Michael W.

doi:10.18553/jmcp.2013.19.s1.s41

Cited by 51 publications

(51 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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 …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Off-label use of DMTs for MS. Presently, the main driver of MS costs is the direct costs for the DMTs, 2,35 whose sales have more than doubled in the last few years. 2 The average annual DMT price in the United States now exceeds $60,000 per patient-year.…”

Section: Develop Alternative Dosing Strategies For Food Andmentioning

confidence: 99%

Reducing costs while enhancing quality of care in MS

Kister

Corboy

2016

Neurology

View full text Add to dashboard Cite

The rapid escalation in prices of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the past decade has resulted in a dramatic overall increase in the costs of MS-related care. In this article, we outline various approaches whereby neurologists can contribute to responsible cost containment while maintaining, and even enhancing, the quality of MS care. The premise of the article is that clinicians are uniquely positioned to introduce innovative management strategies that are both medically sound and cost-efficient. We describe our "top 5" recommendations, including strategies for customizing relapse treatment; developing alternative dosing schedules for Food and Drug Administration-approved MS DMTs; using off-label therapies for relapse suppression; and limiting the use of DMTs to those who clearly fulfill diagnostic criteria, and who might benefit from continued use over time. These suggestions are well-grounded in the literature and our personal experience, but are not always supported with rigorous Class I evidence as yet. We advocate for neurologists to take a greater role in shaping clinical research agendas and helping to establish cost-effective approaches on a firm empiric basis. Neurology ® 2016;87:1617-1622 GLOSSARY DMT 5 disease-modifying therapy; FDA 5 Food and Drug Administration; MS 5 multiple sclerosis; PML 5 progressive multifocal leukoencephalopathy; UBO 5 unidentified bright object.

show abstract

“…6 In the United States, it is estimated that the cost per patient per year can exceed $50,000 (2008 U.S. dollars), 8 while the estimated total lifetime cost to a patient is $4.1 million (2010 U.S. dollars). 9,10 The cost per patient is dependent on many factors, including choice of therapy, the type of MS, disease progression, as well as comorbid conditions. 6,9 An understanding of the frequency of comorbid conditions is crucial, since certain comorbidities may affect the choice of immunomodulatory therapy.…”

mentioning

confidence: 99%

“…9,10 The cost per patient is dependent on many factors, including choice of therapy, the type of MS, disease progression, as well as comorbid conditions. 6,9 An understanding of the frequency of comorbid conditions is crucial, since certain comorbidities may affect the choice of immunomodulatory therapy. Specifically, fingolimod, the sphingosine 1-phosphate receptor modulator, is contraindicated in patients with recent myocardial infarction…”

mentioning

confidence: 99%

Frequency and Economic Impact of Comorbid Cardiac Conditions with Multiple Sclerosis

Franklin¹,

Happe²,

Dillman³

et al. 2014

JMCP

View full text Add to dashboard Cite

show abstract

Perspectives for Managed Care Organizations on the Burden of Multiple Sclerosis and the Cost-Benefits of Disease-Modifying Therapies

Cited by 51 publications

References 84 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

Reducing costs while enhancing quality of care in MS

Frequency and Economic Impact of Comorbid Cardiac Conditions with Multiple Sclerosis

Contact Info

Product

Resources

About