Cost-effectiveness of fingolimod versus interferon beta-1a for relapsing remitting multiple sclerosis in the United States

Lee, Soyon; Baxter, Daniel C.; Limone, Brendan; Roberts, Matthew; Coleman, Craig I.

doi:10.3111/13696998.2012.693553

Cited by 38 publications

(54 citation statements)

References 23 publications

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“…Notwithstanding these factors, HSCT was cost effective, using a yardstick of other treatments considered to be cost-effective in the United Kingdom. For comparison, current MS drug therapy cost effectiveness has been estimated to be between $80,000 to $168,000 per avoided relapse [66,67] or upwards of $73,000 per incremental quality-adjusted life year [68,69].…”

Section: Lesson 10: Information On the Economics And Health Resource mentioning

confidence: 99%

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

Atkins

Freedman

2013

Neurotherapeutics

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Reports from more than 600 hematopoietic stem cell transplants (HSCT) have appeared in the medical literature for the last 1 and one-half decades. The patient's own stem cells are harvested and stored temporarily while high doses of chemotherapy and biologics are used to destroy the auto-destructive immune system. The immune system is regenerated from the infused autologous hematopoietic stem cells. Increasing clinical experience has refined patient selection criteria and management in the peri-transplant period leading to a reduction in treatment-related complications. HSCT, when used to treat patients with aggressive highly active multiple sclerosis, can reduce or eliminate ongoing clinical relapses, halt further progression, and reduce the burden of disability in some patients, in the absence of chronic treatment with disease-modifying agents. The top 10 lessons learned from the growing experience using HSCT for the treatment of multiple sclerosis are discussed.Keywords Hematopoietic stem cell transplantation . Multiple sclerosis . Autoimmunity . Immune ablation There are published reports of more than 600 bone marrowbased transplants performed primarily for the treatment of multiple sclerosis (MS). This review will focus on why and how the hematopoietic stem cell transplantation (HSCT) procedure is used and discuss some of the lessons that can be gleaned from the experience of using HSCT to treat MS.MS is an organ-specific autoimmune disease that results in exclusive central nervous system (CNS) demyelination and axonal damage. Early on, multifocal localized pockets of inflammation lead to transient neurologic dysfunction manifesting as a series of relapses followed by remissions, usually with complete recovery owing to adequate CNS repair. However, as the damage accumulates, repair becomes inadequate and leads to incomplete resolution of disability, culminating in a neurodegenerative process amid a sea of smoldering and changing inflammation. This is probably the underlying state for the clinical stage of secondary progressive MS (SP-MS), a phase characterized by relentless and progressive accumulation of neurological disability with dwindling evidence of discrete relapses [1].Targeting inflammation with interferon-β, glatiramer acetate, natalizumab, fingolimod, and other immune-modulating agents reduces the frequency of relapses, but the impact on delaying the onset, preventing or slowing the tempo of SP-MS remains uncertain [2][3][4]. Several other drugs are in late stage clinical trials and may provide new alternatives for some patients with relapsing-remitting MS (RR-MS). However, despite these therapeutic advances, a subset of patients seem refractory and rapidly develop severe neurological impairment, whereas other patients may have a slower progression of illness that ultimately results in marked functional disabilities. Only a single agent, mitoxantrone, has been shown to temporarily halt or slow the tempo of SP-MS [5,6], but even then, this occurs only in SP-MS patients who have highly act...

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Section: Lesson 10: Information On the Economics And Health Resource mentioning

confidence: 99%

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

Atkins

Freedman

2013

Neurotherapeutics

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“…Altre considerazioni riguardano l'impostazione del modello utilizzato. Da quanto si evince in letteratura, la maggior parte dei modelli farmacoeconomici in sclerosi multipla sono costruiti sul principio in base al quale un trattamento farmacologico riduce la progressione della disabilità e la frequenza e la severità delle ricadute [62][63][64][65]. La conseguenza finale di questo effetto è, in ultima analisi, ritardare la conversione dalla forma SMRR alla forma SMSP.…”

Section: Analisi DI Sensibilitàunclassified

[Cost-effectiveness analysis of delayed-release dimethyl-fumarate in the treatment of relapsing-remitting multiple sclerosis in Italy]

Furneri¹,

Santoni

Marchesi

et al. 2016

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multipla recidivante-remittente (SMRR). Le terapie iniettive di prima linea (interferoni -IFN beta-1a, IFN beta-1b e glatiramer acetato -GA), si sono dimostrate variamente efficaci nel determinare un miglioramento IntroduzIone e obIettIvI dell'analIsINegli ultimi decenni, il trattamento con terapie disease-modifying (DMT) ha permesso di modificare la storia naturale della sclerosi METHODS: The analysis was conducted from the perspective of the Italian National Healthcare Service (NHS) and outcomes and costs were evaluated over a 50-year time horizon (equivalent to a lifetime horizon). Both outcomes and costs were discounted at 3.5%. The Markov model estimates the clinical and economic consequences of treating RRMS patients with the following therapeutic options: DMF, interferon (IFN) beta-1a intramuscular (IM); IFN beta-1a subcutaneous (SC) at two different doses, 22 mcg and 44 mcg; IFN beta-1b SC; glatiramer acetate (GA) SC 20 mg; oral teriflunomide. Clinical efficacy data used in this analysis came from an elaboration of the mixed treatment comparison (MTC) already published. According to the Italian NHS perspective, only the following direct costs were considered: pharmacological treatment acquisition, treatment monitoring, relapse management, direct costs associated with disability, adverse event management. Administration costs were assumed equal to €0, because every treatment included in the economic analysis can be self-administered. One-way and probabilistic sensitivity analyses were developed and cost effectiveness acceptability curves generated. RESULTS: In the base-case analysis, DMF was more efficacious than alternatives, in terms of both survival (19.496 vs. 19.297-19.461 discounted LYs, respectively), and QALYs (6.548 vs. 5.172-6.212 discounted QALYs, respectively). Per-patient lifetime costs with DMF amounted to € 276,500, similarly to the other options. DMF was the drug with the largest effect of disability cost reduction. DMF was dominant vs. IFN beta-1a 44 mcg and cost-effective vs. all other IFNs, GA and teriflunomide, with incremental cost-effectiveness ratio (ICERs) between € 11,272 and € 23,409. All ICER values were lower than the € 50,000 per QALY threshold. One-way sensitivity analysis showed that, for all tested scenarios, ICER of DMF vs. therapeutic alternatives remained favourable (≤ 50.000 €/QALY gained) and the results of probabilistic sensitivity analysis showed that the probability for DMF of being favourable (≤ 50.000 €/QALY gained) was between around 70% and 93%, thus ensuring robustness of the results. CON-CLUSIONS: The results of this economic analysis show that, at the current price and the described assumptions, DMF represents a cost-effective option vs. other available first-line treatments indicated in RRMS in the perspective of the Italian NHS.

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“…Patients can remain for more than one cycle (one month) in any disease state (one EDSS level). Patients remain in the RRMS state as long as they are not transferred to a level higher than EDSS 3 -5.5, and when they are transited to the EDSS 6 -7.5 level or higher, they are considered as SPMS and their remedial medicines are stopped (17). The outcomes used in the model included the mean of relapse avoided as effectiveness and the value of QALY as utility.…”

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

“…Based on the previous studies, one -month Markov cycles as well as a lifetime horizon were used in this study (17,18). To show the clinical course of RRMS (for example, disease progression and relapse), Kurtzke Expanded Disability Status Scale (EDSS) was applied (19).…”

Section: Description Of the Modelmentioning

confidence: 99%

“…Relapse rate (RR) = Number of relapses / Number of years of medicine use Then, the relapse rates of all the patients who used each medicine were summed up and the result was divided into the number of patients who used the same medicine to obtain a mean relapse rate for each medicine (17,33). Next, according to the previous study, the mean relapse rate before using each medicine was considered as 1.002 (34) and the mean relapse rate in the patients who participated in this study was deduced from it to obtain the mean rate of relapse avoided.…”

Section: Health Outcomesmentioning

confidence: 99%

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Cost - effectiveness and Cost - utility of CinnoVex versus ReciGen in Patients with Relapsing - Remitting Multiple Sclerosis in Iran

et al. 2018

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Background: Multiple Sclerosis (MS) is a chronic and inflammatory disease that can affect the patients' quality of life and impose many costs on them. Several types of medicine are used to change the course of the disease, treat disease -related attacks, and treat the symptoms of multiple sclerosis. Objectives: The aim of this study was to determine and compare the cost-effectiveness and cost -utility of CinnoVex versus ReciGen as the first line treatment in patients with relapsing-remitting multiple sclerosis in Iran, Fars province, in 2016. Methods: This study was a cost -effectiveness and cost -utility study, in which a Markov model was used. A sample of 178 patients with MS was randomly selected. The costs were summed up from the societal perspective, and the study outcomes were QALY and the mean of relapse was avoided. To collect the required data, the cost data collection form, Kurtzke Expanded Disability Status Scale, and EQ -5D questionnaire were used. To analyze the data collected, the TreeAge Pro 2011 and Excel 2010 software were used as well. Results:The results showed that the mean cost for ReciGen and CinnoVex patients were 349.84 and 289.92 USD, respectively. In addition, the QALY means were 0.291 and 0.297 and the means of relapse avoided were 0.309 and 0.239 for ReciGen and CinnoVex patients, respectively. The one -way sensitivity analysis showed that the results of the model were sensitive to effectiveness and utility of both medicines, but had little sensitivity to other parameters. Conclusions: According to the results, ReciGen was more cost -effective in terms of relapse avoided and CinnoVex was more costeffective in terms of QALY. Therefore, ReciGen and CinnoVex can be the preferred options for physicians and for health policymakers and managers, respectively.

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Cost-effectiveness of fingolimod versus interferon beta-1a for relapsing remitting multiple sclerosis in the United States

Abstract: Fingolimod use is not likely to be cost-effective compared to IFN beta-1a unless fingolimod cost falls below $3476 per month or a higher than normal willingness-to-pay threshold is accepted by decision-makers.

Cited by 38 publications

References 23 publications

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

[Cost-effectiveness analysis of delayed-release dimethyl-fumarate in the treatment of relapsing-remitting multiple sclerosis in Italy]

Cost - effectiveness and Cost - utility of CinnoVex versus ReciGen in Patients with Relapsing - Remitting Multiple Sclerosis in Iran

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