This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objective: To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) in the United States compared to basic supportive therapy without DMT for patients with relapsing multiple sclerosis (MS).
Methods: Using data from a longitudinal MS survey, we generated 10-year disease progression paths for an MS cohort. We used first-order annual Markov models to estimate transitional probabilities. Costs associated with losses of employment were obtained from the Bureau of Labor Statistics. Medical costs were estimated using the Centers for Medicare and Medicaid Services reimbursement rates and other sources. Outcomes were measured as gains in quality-adjusted life-years (QALY) and relapse-free years. Monte Carlo simulations, resampling methods, and sensitivity analyses were conducted to evaluate model uncertainty.
Results: Using DMT for 10 years resulted in modest health gains for all DMTs compared to treatment without DMT (0.082 QALY or <1 quality-adjusted month gain for glatiramer acetate, and 0.126–0.192 QALY gain for interferons). The cost-effectiveness of all DMTs far exceeded $800,000/QALY. Reducing the cost of DMTs had by far the greatest impact on the cost-effectiveness of these treatments (e.g., cost reduction by 67% would improve the probability of Avonex being cost-effective at $164,000/QALY to 50%). Compared to treating patients with all levels of disease, starting DMT earlier was associated with a lower (more favorable) incremental cost-effectiveness ratio compared to initiating treatment at any disease state.
Conclusion: Use of DMT in MS results in health gains that come at a very high cost.
Footnotes
-
Study funding: Supported in part by contracts HC 0071 and 0103, National Multiple Sclerosis Society (NMSS), New York, NY (program officer: Nicholas LaRocca, PhD), and the University of Rochester CTSA (UL1 RR024160) from the National Center for Research Resources (NCRR), a component of the NIH and the NIH Roadmap for Medical Research.
-
Editorial, page 317
-
Supplemental data at www.neurology.org
-
- CE=
- cost-effectiveness;
- CEAC=
- cost-effectiveness acceptability curve;
- CI=
- confidence interval;
- DMT=
- disease-modifying therapy;
- EDSS=
- Expanded Disability Status Scale;
- FDA=
- Food and Drug Administration;
- HRQOL=
- health-related quality of life;
- ICER=
- incremental cost-effectiveness ratio;
- ICD-9-CM=
- International Classification of Diseases–9–Clinical Modification;
- MC=
- Monte Carlo;
- MEPS=
- Medical Expenditure Panel Survey;
- MS=
- multiple sclerosis;
- QALY=
- quality-adjusted life-year;
- RRMS=
- relapsing-remitting multiple sclerosis;
- RFY=
- relapse-free year;
- SC=
- subcutaneous;
- SF-36=
- Short Form–36;
- SPMS=
- secondary progressive multiple sclerosis
- Received May 14, 2010.
- Accepted February 18, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
AAN Members: Sign in with your AAN member credentials (e-mail or 6-digit Member ID number)
Non-AAN Member subscribers: Sign in with subscriber credentials
Log in using your username and password
Purchase access
Disputes & Debates: Rapid online correspondence
NOTE: All contributors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.