Stephanie R. Earnshaw (RTI Health Solutions, Research Triangle Park, North Carolina, USA Teva Neuroscience, Inc., Kansas City, Missouri, USA Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA1 RTI Health Solutions, Research Triangle Park, North Carolina, USA) Jonathan Graham (RTI Health Solutions, Research Triangle Park, North Carolina, USA Teva Neuroscience, Inc., Kansas City, Missouri, USA Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA1 RTI Health Solutions, Research Triangle Park, North Carolina, USA) MerriKay Oleen-Burkey (RTI Health Solutions, Research Triangle Park, North Carolina, USA Teva Neuroscience, Inc., Kansas City, Missouri, USA Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA2 Teva Neuroscience, Inc., Kansas City, Missouri, USA) Jane Castelli-Haley (RTI Health Solutions, Research Triangle Park, North Carolina, USA Teva Neuroscience, Inc., Kansas City, Missouri, USA Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA2 Teva Neuroscience, Inc., Kansas City, Missouri, USA) Kenneth Johnson (RTI Health Solutions, Research Triangle Park, North Carolina, USA Teva Neuroscience, Inc., Kansas City, Missouri, USA Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA3 Maryland Center for Multiple Sclerosis, School of Medicine, University of Maryland, Baltimore, Maryland, USA)
Abstract
Background: Disease-modifying drugs are a significant expenditure for treating multiple sclerosis. Natalizumab (NZ) has been shown to be effective in reducing relapses and disease progression. However, assessment of the cost effectiveness of NZ compared with other disease-modifying drugs in the presence of long-term data has been limited. Objective: To assess the lifetime cost effectiveness from the US healthcare and societal perspectives of glatiramer acetate (GA) and NZ (both given with symptom management) relative to symptom management alone in patients with relapsing-remitting multiple sclerosis (RRMS) using evidence from long-term published studies. Methods: A Markov model was developed with patients transitioning through health states based on Kurtzke's expanded disability status scale (EDSS). Patients were ≥18 years of age with RRMS, EDSS <6.0 and receiving treatment. Treatment effects were obtained from clinical trials for years 1 and 2 of therapy and long-term clinical assessments thereafter. Transitions were adjusted for discontinuation and persistent NZ antibodies. Patients incurred drug, other medical and lost worker productivity costs. Patient quality of life was considered in the form of utilities, which were taken from assessments of patients with MS. Costs were valued in 2007 $US, and costs and outcomes were discounted at 3% per annum. Various parameters and assumptions were tested in one-way sensitivity analyses, and scenario-based analyses were also performed. Results: Remaining lifetime, direct medical costs for patients receiving GA or NZ versus symptom management were $US408 000, $US422 208 and $US341 436, respectively. Patients receiving GA or NZ benefited from increased years in EDSS 0.0-5.5 (1.18 and 1.09, respectively), years relapse-free (1.30 and 1.18) and QALYs (0.1341 and 0.1332). The incremental cost per QALY for GA or NZ compared with symptom management was $US496 222 and $US606 228, respectively, excluding lost worker productivity costs. GA was associated with a cost saving compared with NZ. The incremental cost per QALY results were sensitive to changes in time horizon, disease progression and drug costs. Improved QALYs for NZ were sensitive to changes in the clinical effect of NZ on disease progression and discontinuation over time. Conclusions: GA or NZ in RRMS patients is associated with increased benefits compared with symptom management, albeit at higher costs. Although year 1 and 2 disease progression and relapse rates were better for NZ than GA, long-term evidence may show GA to have similar, if not improved, clinical benefit.
Download Info
To download:
If you experience problems downloading a file, check if you have the
proper application to
view it first. Information about this may be contained
in the File-Format links below. In case of further problems read
the IDEAS help
page. Note that these files are not on the IDEAS
site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
For technical questions regarding this item, or to correct its listing, contact: (Remco Bouckaert).
Related research
Keywords:
Find related papers by JEL classification: C - Mathematical and Quantitative Methods D - Microeconomics I - Health, Education, and Welfare Z - Other Special Topics I1 - Health, Education, and Welfare - - Health I19 - Health, Education, and Welfare - - Health - - - Other I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets