Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis

Abstract

Objective To evaluate the cost utility of interferon beta-1b in secondary progressive multiple sclerosis. Design Population based cost utility model (healthcare perspective). Data on use of health services were obtained from case records and routine morbidity data and utility values from a EuroQol survey. Local and published costs were used. Effectiveness was modelled using data on relative risk reductions from a randomised trial of interferon beta-1b. Setting Tayside region, 1993-5. Subjects 132 ambulatory people with secondary progressive multiple sclerosis. Main outcome measures Cost per quality adjusted life year (QALY) gained. Rate of relapse and proportion becoming wheelchair dependent over three years. Results The number needed to treat for 30 months to delay time to wheelchair dependence in one person by nine months was 18 (95% confidence interval 5 to 26). For every 18 people treated for 30 months, six relapses would be prevented, gaining 0.397 discounted QALYs. The cost per QALY gained was £1 024 667 (£276 466 to £1 485 499). If treatment was restricted to patients attending neurology services, the number needed to treat was 14 (cost per QALY gained £833 514 (£161 358 to ∞)). The cost per QALY gained was not sensitive to changes in cost which took account of a societal perspective. Conclusions The cost per QALY gained from interferon beta is high because of the high drug cost and modest clinical effect. Resources could be used more efficiently elsewhere..

Methods for expected value of information analysis in complex health economic models: developments on the health economics of interferon-β and glatiramer acetate for multiple sclerosis

“…The sum of the main effects of the first 32 variables [y (32) ] would now be compared with y (0) ; if these values proved to be equal, this would indicate that none of the individual main effects of the first 32 factors was important. It would also compare y (64) and y (32) ; if these values were found to be different, it would indicate that at least one parameter from parameters 33-64 was important.…”

“…It would also compare y (64) and y (32) ; if these values were found to be different, it would indicate that at least one parameter from parameters 33-64 was important. This process would continue, splitting parameters 33-64 up into smaller and smaller groups and comparing the values of the resulting ys, until the most important parameters were identified.…”

“…Existing analyses have produced a range of cost-effectiveness estimates from in excess of £1 million per QALY gained to cost saving. [30][31][32] Significant flaws in the modelling of natural history, efficacy, discontinuation of therapy, mortality and the treatment of uncertainty mean that none of these estimates can be considered robust. 33 In general, those models which produced very high cost-effectiveness estimates tended to have shorter time horizons (less than 10 years) or assumed that all benefit ceased when the patient stopped therapy.…”

Prioritisation of health technology assessment. The PATHS model: methods and case studies

“…[89][90][91] Forbes and co-workers 92 looked at cost utility in a possible subgroup of ambulatory SP-MS patients with more active disease, but still estimated a cost per QALY of over £800,000 (95% CI £161,000 to infinity). The subsequent detailed cost-effectiveness modelling has produced lower estimates of the cost per QALY but, at the then prevailing prices, still not within normally accepted limits for the NHS.…”

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

“…45,48 Numerous studies have assessed the cost per QALY of the approved DMTs for MS, aside from fingolimod (Table 4). 45,47,48,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] These studies arrived at widely different estimates, with costs per QALY varying from around $20,000 to over $1 million.…”