A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis

Newton, Ashley; Stica, Christina M.

doi:10.7224/1537-2073-13.3.128

Cited by 8 publications

(3 citation statements)

References 16 publications

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“…These observed differences may be due to many different reasons including the dosing regimens used and differences in the molecular structure or post-translational modifications. The lower immunogenicity of Avonex™ needs to be balanced against the relative cost-effectiveness, which may be as favourable when compared to the other formulations [65]. Currently, European Federation of Neurological Societies (EFNS) guidelines suggest patients treated with IFN-β are investigated for the presence of NAbs at 12 and 24 months.…”

Section: Discussionmentioning

confidence: 98%

Development of interferon beta-neutralising antibodies in multiple sclerosis—a systematic review and meta-analysis

Govindappa

Sathish

Park

et al. 2015

Eur J Clin Pharmacol

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Section: Discussionmentioning

confidence: 98%

Development of interferon beta-neutralising antibodies in multiple sclerosis—a systematic review and meta-analysis

Govindappa

Sathish

Park

et al. 2015

Eur J Clin Pharmacol

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“…With an average of 17.65 years until the first positive test in these patients, and assuming they became positive within the first two years of treatment [ 34 ], they have had less efficient treatment for over a decade. With the yearly cost of IFNβ-1b-Betaferon treatment ranging from $16,000–$25,000 [ 40 , 41 ], the total cost of a patient found positive after two years of treatment would be up to $391,250 (15.65 x $25,000) per person. These types of overall health care costs and benefits have to be considered for all current used BPs individually in conjunction with costs for ADA screening, but might be especially beneficial for very expensive drugs if these are monoclonal antibodies where ADA can be detected early after treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

Clinical practice of analysis of anti-drug antibodies against interferon beta and natalizumab in multiple sclerosis patients in Europe: A descriptive study of test results

et al. 2017

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Antibodies against biopharmaceuticals (anti-drug antibodies, ADA) have been a well-integrated part of the clinical care of multiple sclerosis (MS) in several European countries. ADA data generated in Europe during the more than 10 years of ADA monitoring in MS patients treated with interferon beta (IFNβ) and natalizumab have been pooled and characterized through collaboration within a European consortium. The aim of this study was to report on the clinical practice of ADA testing in Europe, considering the number of ADA tests performed and type of ADA assays used, and to determine the frequency of ADA testing against the different drug preparations in different countries. A common database platform (tranSMART) for querying, analyzing and storing retrospective data of MS cohorts was set up to harmonize the data and compare results of ADA tests between different countries. Retrospective data from six countries (Sweden, Austria, Spain, Switzerland, Germany and Denmark) on 20,695 patients and on 42,555 samples were loaded into tranSMART including data points of age, gender, treatment, samples, and ADA results. The previously observed immunogenic difference among the four IFNβ preparations was confirmed in this large dataset. Decreased usage of the more immunogenic preparations IFNβ-1a subcutaneous (s.c.) and IFNβ-1b s.c. in favor of the least immunogenic preparation IFNβ-1a intramuscular (i.m.) was observed. The median time from treatment start to first ADA test correlated with time to first positive test. Shorter times were observed for IFNβ-1b-Extavia s.c. (0.99 and 0.94 years) and natalizumab (0.25 and 0.23 years), which were introduced on the market when ADA testing was already available, as compared to IFNβ-1a i.m. (1.41 and 2.27 years), IFNβ-1b-Betaferon s.c. (2.51 and 1.96 years) and IFNβ-1a s.c. (2.11 and 2.09 years) which were available years before routine testing began. A higher rate of anti-IFNβ ADA was observed in test samples taken from older patients. Testing for ADA varies between different European countries and is highly dependent on the policy within each country. For drugs where routine monitoring of ADA is not in place, there is a risk that some patients remain on treatment for several years despite ADA positivity. For drugs where a strategy of ADA testing is introduced with the release of the drug, there is a reduced risk of having ADA positive patients and thus of less efficient treatment. This indicates that potential savings in health cost might be achieved by routine analysis of ADA.

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“…Multiple sclerosis disease-modifying treatments are expensive and of long duration, and their effectiveness to delay the SP stage of the disease is debatable. The costs of diseasemodifying therapies, such as fingolimod and natalizumab, average approximately $30 000 per year per patient, [3][4][5] and additional indirect costs associated with MS treatment push the total costs even higher.…”

mentioning

confidence: 99%

Effect of Smoking Cessation on Multiple Sclerosis Prognosis

et al. 2015

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IMPORTANCE Smoking tobacco is a well-established risk factor for multiple sclerosis (MS), a chronic inflammatory disorder of the central nervous system usually characterized by bouts and remissions and typically followed by a secondary progressive (SP) course. However, it is not clear whether smoking after diagnosis is detrimental. OBJECTIVE To determine whether smoking after MS diagnosis is associated with a change in time to SP disease. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of patients with prevalent MS who smoked at diagnosis (n = 728) taken from the Genes and Environment in Multiple Sclerosis Study, which consists of patients from the Swedish National MS Registry. The study entrance date was at time of first-year smoking. The study was conducted between November 2008 and December 2011, with patient environmental data collected from November 2009 to March 2011 via questionnaire. Study participants were from all counties in Sweden diagnosed as having MS at the time of the Genes and Environment in Multiple Sclerosis Study and registered in the Swedish National MS Registry. Patients with MS with relapsing-remitting disease course or SP were included. These patients' conditions were diagnosed according to the McDonald criteria and the patients responded to recruitment letters with detailed questionnaires. EXPOSURE Smoking, considered yearly after diagnosis and combined into a time-invariant covariate before diagnosis. MAIN OUTCOMES AND MEASURES Time to SPMS, measured using an accelerated failure time model, with smoking as a time-varying covariate. Other covariates included sex, age at diagnosis, snuff use, and smoking before diagnosis. RESULTS The optimized model illustrated that each additional year of smoking after diagnosis accelerated the time to conversion to SPMS by 4.7% (acceleration factor, 1.047; 95% CI, 1.023-1.072; P < .001). Kaplan-Meier plots demonstrated that those who continued to smoke continuously each year after diagnosis converted to SPMS faster than those who quit smoking, reaching SP disease at 48 and 56 years of age, respectively. CONCLUSIONS AND RELEVANCE This study provides evidence that continued smoking is associated with an acceleration in time to SPMS and that those who quit fare better. Therefore, we propose that patients with MS should be advised to stop smoking once a diagnosis has been made, not only to lessen risks for comorbidities, but also to avoid aggravating MS-related disability.

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A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis

Cited by 8 publications

References 16 publications

Development of interferon beta-neutralising antibodies in multiple sclerosis—a systematic review and meta-analysis

Development of interferon beta-neutralising antibodies in multiple sclerosis—a systematic review and meta-analysis

Clinical practice of analysis of anti-drug antibodies against interferon beta and natalizumab in multiple sclerosis patients in Europe: A descriptive study of test results

Effect of Smoking Cessation on Multiple Sclerosis Prognosis

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