Multiple Sclerosis (MS) is a progressive disease leading to increasing disability and costs. A literature review was carried out to identify MS costs and to estimate its economic burden in Spain. Areas Covered: The public electronic databases PubMed, ScienceDirect and IBECS were consulted and a manual review of communications presented at related congresses was carried out. A total of 225 references were obtained, of which 43 were finally included in the study. Expert Commentary: Three major cost groups were identified: direct healthcare costs, direct non-healthcare costs and indirect costs. There is a direct relationship between disease progression and increased costs, mainly direct non-healthcare costs (greater need for informal care) and indirect costs (greater loss of productivity). The total cost associated with MS in Spain is €1,395 million per year, and that the mean annual cost per patient is €30,050. Beyond costs, a large impact on the quality of life of patients, with an annual loss of up to 13,000 quality-adjusted life years was also estimated. MS has a large economic impact on Spanish society and a significant impact on the quality of life of patients.

Objective: To estimate the cost-effectiveness of Cladribine Tablets in the treatment of relapsing multiple sclerosis (RMS) with high disease activity compared with fingolimod, from the perspective of the National Health System (NHS) in Spain. Methods: A Markov model was developed. The annual transition probabilities, were adjusted to patients with RMS with high disease activity. The effect of the treatments compared on the Expanded Disability Status Scale (EDSS) was modeled by hazard ratios for the confirmed progression of disability. The annual relapse rate and the probability of suffering adverse reactions were obtained from a meta-analysis and the literature. The derived costs were calculated from Spanish unit costs. The utilities were obtained from the CLARITY clinical trial and the literature. Deterministic and probabilistic sensitivity analyzes were performed. Results: Cladribine tablets was the dominant treatment: lower costs (−86,536 €) and more effective (+1.11 quality-adjusted life years-QALYs) compared to fingolimod. The probability that Cladribine Tablets was costeffective compared to fingolimod ranged between 94.6% and 96.1% for willingness to pay from € 20,000 to € 30,000 per QALY gained. Conclusions: Cladribine Tablets is a cost-effective treatment, compared to fingolimod, for the treatment of RMS with high disease activity. Expert Opinion: According to the present study, compared to fingolimod, treatment with Cladribine Tablets of relapsing multiple sclerosis with high disease activity is an option that could generate savings for the Spanish National Health System, with a considerable gain in QALYs. Cladribine Tablets is considered cost-effective and dominant (less costs and more effectiveness) than fingolimod treatment option in this population.

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EinleitungDie Moglichkeit, bei kurz vor der Pubertat stehenden Jungsauen eine ovulatorische Brunst auszulosen, ist aus fruheren Untersuchungen bekannt (HOLTZ u. Mitarb., 1978). Wie von SCHILLING und MINAR (1971) sowie HOLTZ und Mitarbeiter (1978) nach ewiesen wurde, kann bei Besamung der stehend aus 400 I. E. PMS und 200 I. E. HCG, ein relativ gutes Fruchtbarkeitsergebnis erzielt werden. Aus wirtschaftlichen und arbeitstechnischen Grunden ware es wunschenswert, mit einer einzigen Besamung auszukommen, indem der Ovulationszeitpunkt zeitlich genau fixiert wird. Die dem Follikelsprung zugrunde liegenden physiologischen Vorgange sind keineswegs restlos eklart. Ohne Frage spielt in diesem Zusammenhang Gipfel eine Schlusselrolle (SCHWARTZ, 1973). In Versuchen von DZIUK und GEHLBACH, 1966; BAKER und COGGINS, 1968; BAKER und Mitarbeiter, 1969; SHAW und Mitarbeiter, 1971 ; SEGAL und BAKER, 1973, wurde dieser Vorgang imitiert, indem etwa 48 h nach der Stimulation der Eierstockstatigkeit durch PMS eine HCG-Gabe verabreicht wurde. Die dem endogenen L H vergleichbare Wirkung des H C G fuhrte in der Regel nach etwa 40-42 h zum Follikelsprung. Die Frage, inwieweit H C G oder eine andere Substanz in der Lage ist, bei mit einem PMS/HCG-Gemisch vorbehandelten Jungsauen durch seine Vorverlegung eine zuverlassige zeitliche Determinierung des Follikelsprungs herbeizufuhren, ist Gegenstand der vorliegenden Untersuchung. Tiere am 4. und 5. Tag nach der Inje f tion eines Hormon-Mischpraparates, beder, wahrscheinlich dur 4 einen Ustrogenanstieg ausgeloste, ovulatorische LH-U. S .