Cost-Utility Analysis of Disease-Modifying Drugs in Relapsing-Remitting Multiple Sclerosis in Iran

Abstract

BackgroundDisease-modifying drugs (DMDs) are a significant expenditure for treating multiple sclerosis (MS). However, there is limited report on assessment of the cost-utility of DMDs compared with symptom management in the presence of long-term data. This study aimed to assess the lifetime cost-utility from the Iranian healthcare perspectives of 4DMDs relative to symptom management alone in patients with relapsing-remitting multiple sclerosis using evidence from long-term published studies.MethodsA Markov model was developed with patients transitioning through health states based on Kurtzke's expanded disability status scale.Patient costs included drug costs, other medical and lost worker productivity costs. Patient quality of life was considered in the form of utilities. Costs were valued in 2011 USD, and were discounted at 7.2% per annum. Various parameters and assumptions were tested in sensitivity analyses.ResultsTotal costs per patient over the time horizon of a patient's lifetime were estimated at 20285, 144194, 299279, 251255 and 69796 USD for symptom management, Avonex, Betaferon, Rebif and CinnoVex, respectively. As a result, the incremental cost per quality adjusted life years (QALY) for patients receiving Avonex, Betaferon, Rebif and CinnoVex was 607397, 1374355, 1166515 and 1010429 USD, respectively, when compared with symptom management. The results were sensitive to changes in time horizon, disease progression and drug costs.ConclusionDMDs in relapsing-remitting MS patients was associated with increased benefits compared with symptom management, albeit at higher costs. Because patients receiving Avonex incurred slightly higher QALYs than patients receiving other DMDs, treatment with Avonex dominates other DMDs in Iran.

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

“…Hence, the highest costs in treatment with both medications were direct medical costs, in which the largest costs were related to the costs of purchasing the main medicine, which were 64.29% and 46.16%, respectively. The results of the present study are in line with those of the studies conducted by and Nikfar et al, (2013) (24,40).…”

“…, using the utility index (QALY) to compare these two medicines, indicated that intramuscular Interferon beta1a (Avonex) was more cost -effective than subcutaneous Interferon beta -1 (Rebif) (21,24,28,45).…”

Clinical effectiveness and cost-effectiveness of beta-interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation

“…On the basis of title and abstract, 1168 records were excluded and the remaining 225 records were included for full-text screening. A further 213 articles were excluded at the full-text stage (see Appendix 7 for a list of excluded studies with reasons), leaving 10 studies 154,[264][265][266][267][268][269][270][271][272] that included a decision-analytic model used to estimate the cost-effectiveness of DMTs for treating people with RRMS. …”

“…All of the studies included an economic model to estimate the cost-effectiveness of DMTs for treating people with RRMS. The economic evaluations were mainly conducted in the USA 266,267,272 and Spain, 264,268,270 with two studies carried out in Iran 265,269 and the remaining studies carried out in the UK 154 and France. 271 Studies mainly compared IM IFN-β-1a once weekly, SC IFN-β-1a three times weekly, SC IFN-β-1b or SC GA with symptom management.…”

“…271 Studies mainly compared IM IFN-β-1a once weekly, SC IFN-β-1a three times weekly, SC IFN-β-1b or SC GA with symptom management. 264,265,269,270 Two studies compared IM IFN-β-1a once weekly with GA, 154,268 one study compared SC IFN-β-1b with symptom management, 267 two studies included IM IFN-β-1a once weekly in their intervention compared with fingolimod 266,272 and the remaining study included comparisons between IFN-β-1a, IFN-β-1b or GA and dimethyl fumarate. 271 154,[268][269][270][271][272] or biennial 265 and time horizons ranged from 2 years 266 up to death.…”