Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis.

OBJECTIVE To perform a cost-effectiveness analysis of three immunomodulatory treatments for newly diagnosed nonprimary progressive MS: interferon beta-1a, interferon beta-1b, and glatiramer acetate. METHODS We developed a state-transition model to estimate the health effects and costs associated with interferon beta-1a, interferon beta-1b, glatiramer acetate, and no treatment for hypothetical cohorts of men and women with non-primary progressive MS. We used the Expanded Disability Status Scale as the measure of disability and included both relapses and disease progression in the model. We evaluated treatment strategies assuming a 10-year treatment duration using the societal perspective. We elicited preferences for disability and treatment states using standard-gamble questions and modeled the disutility associated with treatment administration and side effects explicitly. Main outcome measures were net gains in quality-adjusted life expectancy and incremental cost-effectiveness ratios in dollars per quality-adjusted life year (QALY) gained. RESULTS For treatment duration of 10 years for newly diagnosed non-primary progressive MS, interferon beta-1a yielded the largest gain in quality-adjusted life expectancy with an incremental cost-effectiveness ratio of $2,200,000/QALY for women and $1,800,000/QALY for men, compared with no treatment. For a 5-year treatment duration, a "no treatment" strategy yielded more quality-adjusted life years than any of the treatment strategies. Cost-effectiveness ratios were similar for all three immunomodulatory treatments evaluated. CONCLUSIONS Cost-effectiveness results for all three immunomodulatory treatments for MS were unfavorable in the simulated study population under a wide range of assumptions. For treatment duration less than or equal to 5 years, expected benefits of treatment may not outweigh disutility associated with side effects and treatment discomfort.

[1]  N. Waugh,et al.  Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis , 1999, BMJ.

[2]  J. Baskerville,et al.  The natural history of multiple sclerosis: a geographically based study: 8: familial multiple sclerosis. , 2000, Brain : a journal of neurology.

[3]  M. Von Korff,et al.  Chronic care costs in managed care. , 1997, Health affairs.

[4]  D. Paty,et al.  Cause of death in patients attending multiple sclerosis clinics , 1991, Neurology.

[5]  Jeffrey A. Cohen,et al.  Newer Versus Older Treatments for Relapsing-Remitting Multiple Sclerosis , 1996, Drug safety.

[6]  B. Jönsson,et al.  COST-UTILITY ANALYSIS OF INTERFERON BETA-1B IN SECONDARY PROGRESSIVE MULTIPLE SCLEROSIS , 2000, International Journal of Technology Assessment in Health Care.

[7]  R. Rudick,et al.  Exacerbation rates and adherence to disease type in a prospectively followed-up population with multiple sclerosis. Implications for clinical trials. , 1989, Archives of neurology.

[8]  R. Inman.  The Economic Consequences of Debilitating Illness: The Case of Multiple Sclerosis , 1987 .

[9]  M. Stacy,et al.  An Open‐Labelled Assessment of Adverse Effects Associated with Interferon 1‐Beta in the Treatment of Multiple Sclerosis , 1995, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[10]  O. Andersen,et al.  Prognostic factors in a multiple sclerosis incidence cohort with twenty-five years of follow-up. , 1993, Brain : a journal of neurology.

[11]  P. O'Brien,et al.  Health care utilization in multiple sclerosis , 1998, Neurology.

[12]  K Whetten-Goldstein,et al.  A comprehensive assessment of the cost of multiple sclerosis in the United States , 1998, Multiple sclerosis.

[13]  J. G. Phadke.  Survival pattern and cause of death in patients with multiple sclerosis: results from an epidemiological survey in north east Scotland. , 1987, Journal of neurology, neurosurgery, and psychiatry.

[14]  D. Goodin,et al.  Side effect profile of interferon beta-lb in MS , 1996, Neurology.

[15]  Amit Bar-Or,et al.  Patient and community preferences for treatments and health states in multiple sclerosis , 2003, Multiple sclerosis.

[16]  D. Goodkin,et al.  Side effect profile and adherence to in the treatment of Multiple Sclerosis with interferon beta-la , 1998, Multiple sclerosis.

[17]  J. W. Rose,et al.  Copolymer 1 reduces relapse rate and improves disability in relapsing‐remitting multiple sclerosis , 1995, Neurology.

[18]  Marco Rovaris,et al.  Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study , 2001, The Lancet.

[19]  D. Goodin.  Survey of multiple sclerosis in Northern California , 1999 .

[20]  D. Miller,et al.  The natural history of multiple sclerosis: a regional study with some longitudinal data. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[21]  J. Law,et al.  Screening for speech and language delay: a systematic review of the literature. , 1998, Health technology assessment.

[22]  H. Hartung,et al.  Familial multiple sclerosis , 1988, Journal of the Neurological Sciences.

[23]  G. Ebers,et al.  NATURAL HISTORY OF MULTIPLE SCLEROSIS , 2001, Journal of neurology, neurosurgery, and psychiatry.

[24]  R. N. Anderson,et al.  United States life tables, 1998. , 2001, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[25]  S. Cole,et al.  Interferon β‐1a for early multiple sclerosis: CHAMPS trial subgroup analyses , 2002 .

[26]  C. Granger,et al.  Intramuscular interferon beta‐1a for disease progression in relapsing multiple sclerosis , 1996, Annals of neurology.

[27]  B. Weinshenker,et al.  The Natural History of Multiple Sclerosis: Update 1998 , 1998, Seminars in neurology.

[28]  B Bass,et al.  The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course. , 1989, Brain : a journal of neurology.

[29]  P. Duquette,et al.  Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. , 1993 .

[30]  H. Brønnum-Hansen,et al.  Underlying cause of death in Danish patients with multiple sclerosis: results from the Danish Multiple Sclerosis Registry , 1998, Journal of neurology, neurosurgery, and psychiatry.

[31]  A. Jacoby,et al.  A cost-utility analysis of interferon beta for multiple sclerosis. , 1998, Health technology assessment.

[32]  B. Jönsson,et al.  COST-UTILITY ANALYSIS OF INTERFERON BETA-1B IN SECONDARY PROGRESSIVE MULTIPLE SCLEROSIS USING NATURAL HISTORY DISEASE DATA , 2002, International Journal of Technology Assessment in Health Care.

[33]  J. Baskerville,et al.  The natural history of multiple sclerosis: a geographically based study. 5. The clinical features and natural history of primary progressive multiple sclerosis. , 1999, Brain : a journal of neurology.

[34]  R. P. Kinkel,et al.  Impact of interferon beta-1a on neurologic disability in relapsing multiple sclerosis , 1997, Neurology.

[35]  S. Reingold,et al.  Defining the clinical course of multiple sclerosis , 1996, Neurology.

[36]  J. Baskerville,et al.  The natural history of multiple sclerosis: a geographically based study. 3. Multivariate analysis of predictive factors and models of outcome. , 1991, Brain : a journal of neurology.

[37]  C. Schwartz,et al.  COST-EFFECTIVENESS OF INTERFERON BETA-1B IN SLOWING MULTIPLE SCLEROSIS DISABILITY PROGRESSION , 2000, International Journal of Technology Assessment in Health Care.

[38]  F. Lublin,et al.  Management of patients receiving interferon beta-1b for multiple sclerosis , 1996, Neurology.

[39]  Anthony O'Hagan,et al.  Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. Commentary: evaluating disease modifying treatments in multiple sclerosis. , 2003, BMJ : British Medical Journal.

[40]  B Bass,et al.  The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. , 1989, Brain : a journal of neurology.

[41]  R. Knobler,et al.  Systemic recombinant human interferon-beta treatment of relapsing-remitting multiple sclerosis: pilot study analysis and six-year follow-up. , 1993, Journal of interferon research.

[42]  J H Simon,et al.  Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. , 2000, The New England journal of medicine.

[43]  L. Jönsson,et al.  Cost-utility of interferon β1b in the treatment of patients with active relapsing-remitting or secondary progressive multiple sclerosis , 2003, The European Journal of Health Economics.

[44]  D. Bourdette,et al.  Health care costs of veterans with multiple sclerosis: Implications for the rehabilitation of MS , 1993 .

[45]  D. Mohr,et al.  Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-lb: Relationship to adherence to treatment , 1996, Multiple sclerosis.

[46]  L. Jacobs,et al.  A profile of multiple sclerosis: The New York State Multiple Sclerosis Consortium , 1999, Multiple sclerosis.