Experiences of <scp>UK</scp> health‐care services for people with <scp>M</scp>ultiple <scp>S</scp>clerosis: a systematic narrative review

Methley, Abigail; Chew‐Graham, Carolyn; Campbell, Stephen; Cheraghi-Sohi, Sudeh

doi:10.1111/hex.12228

Cited by 35 publications

(44 citation statements)

References 31 publications

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“…113 A recent qualitative systematic review emphasises the importance of support from health-care providers and an accessible health-care system. 114 A comprehensive care plan including patient and carer support alongside therapeutics is described as key for successful management of MS. 115 …”

Section: Costmentioning

confidence: 99%

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

Melendez‐Torres

Auguste

Armoiry

et al. 2017

Health Technol Assess

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Background At the time of publication of the most recent National Institute for Health and Care Excellence (NICE) guidance [technology appraisal (TA) 32] in 2002 on beta-interferon (IFN-β) and glatiramer acetate (GA) for multiple sclerosis, there was insufficient evidence of their clinical effectiveness and cost-effectiveness. Objectives To undertake (1) systematic reviews of the clinical effectiveness and cost-effectiveness of IFN-β and GA in relapsing–remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) and clinically isolated syndrome (CIS) compared with best supportive care (BSC) and each other, investigating annualised relapse rate (ARR) and time to disability progression confirmed at 3 months and 6 months and (2) cost-effectiveness assessments of disease-modifying therapies (DMTs) for CIS and RRMS compared with BSC and each other. Review methods Searches were undertaken in January and February 2016 in databases including The Cochrane Library, MEDLINE and the Science Citation Index. We limited some database searches to specific start dates based on previous, relevant systematic reviews. Two reviewers screened titles and abstracts with recourse to a third when needed. The Cochrane tool and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Philips checklists were used for appraisal. Narrative synthesis and, when possible, random-effects meta-analysis and network meta-analysis (NMA) were performed. Cost-effectiveness analysis used published literature, findings from the Department of Health’s risk-sharing scheme (RSS) and expert opinion. A de novo economic model was built for CIS. The base case used updated RSS data, a NHS and Personal Social Services perspective, a 50-year time horizon, 2014/15 prices and a discount rate of 3.5%. Outcomes are reported as incremental cost-effectiveness ratios (ICERs). We undertook probabilistic sensitivity analysis. Results In total, 6420 publications were identified, of which 63 relating to 35 randomised controlled trials (RCTs) were included. In total, 86% had a high risk of bias. There was very little difference between drugs in reducing moderate or severe relapse rates in RRMS. All were beneficial compared with BSC, giving a pooled rate ratio of 0.65 [95% confidence interval (CI) 0.56 to 0.76] for ARR and a hazard ratio of 0.70 (95% CI, 0.55 to 0.87) for time to disability progression confirmed at 3 months. NMA suggested that 20 mg of GA given subcutaneously had the highest probability of being the best at reducing ARR. Three separate cost-effectiveness searches identified > 2500 publications, with 26 included studies informing the narrative synthesis and model inputs. In the base case using a modified RSS the mean incremental cost was £31,900 for pooled DMTs compared with BSC and the mean incremental quality-adjusted life-years (QALYs) were 0.943, giving an ICER of £33,800 per QALY gained for people with RRMS. In probabilistic sensitivity analysis the ICER was £34,000 per QALY gained. In sensitivity analysis, using the assessment group inputs gave an ICER of £12,800 per QALY gained for pooled DMTs compared with BSC. Pegylated IFN-β-1 (125 µg) was the most cost-effective option of the individual DMTs compared with BSC (ICER £7000 per QALY gained); GA (20 mg) was the most cost-effective treatment for CIS (ICER £16,500 per QALY gained). Limitations Although we built a de novo model for CIS that incorporated evidence from our systematic review of clinical effectiveness, our findings relied on a population diagnosed with CIS before implementation of the revised 2010 McDonald criteria. Conclusions DMTs were clinically effective for RRMS and CIS but cost-effective only for CIS. Both RCT evidence and RSS data are at high risk of bias. Research priorities include comparative studies with longer follow-up and systematic review and meta-synthesis of qualitative studies. Study registration This study is registered as PROSPERO CRD42016043278. Funding The National Institute for Health Research Health Technology Assessment programme.

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Section: Costmentioning

confidence: 99%

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

Melendez‐Torres

Auguste

Armoiry

et al. 2017

Health Technol Assess

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“…Particular techniques like health coaching and motivational interviewing can enhance adherence to rehabilitation interventions. The delivery of timely and accurate informational support can improve emotional well-being and increase physical activity [19][20][21]. Literature has highlighted the indirect, positive effect that social support has on physical activity in MS participants, through increasing levels of self-ef icacy [22,23].…”

Section: Social Supportmentioning

confidence: 99%

“…Literature has highlighted the indirect, positive effect that social support has on physical activity in MS participants, through increasing levels of self-ef icacy [22,23]. MS patients typically rely heavily upon health professionals to provide this support [21]. However, review evidence [24,25] has identi ied poor interactions between patients with MS and health care professionals.…”

Section: Social Supportmentioning

confidence: 99%

“…This is unsurprising given the reduced patient-professional contact time that typically exists in telerehabilitation interventions. In past literature, patients with chronic diseases, such as MS, have relied on established patient-practitioner relationships as a primary source of social support [21]. Clearly the opportunity to develop meaningful relationships with staff is limited due to the reduced contact time, particularly during home-based interventions.…”

Section: Providers Of Social Supportmentioning

confidence: 99%

“…This is supported by past literature, which found signi icant associations between informational support and health promotion with consequential increases in physical activity [19] and there are a number of reasons as to why this could be. Methley [21], highlighted the bene its of timely information delivery on participants' emotional wellbeing. Half of the included studies provided intervention information prior to study commencement in addition to information throughout the study.…”

Section: Benefi Ts Attributable To Social Supportmentioning

confidence: 99%

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Determining the use and value of social support in Telerehabiliation Interventions for individuals with Multiple Sclerosis: A narrative synthesis review

Soundy¹

2017

J Nov Physiother Rehabil

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Background: Telerehabilitation has been identifi ed as an effective treatment that promotes exercise rehabilitation in individuals with multiple sclerosis (MS). Social support is recognised as a core element of such interventions. However further research is needed to consider the role and value of different social support domains. Aim:Review available literature to assess and synthesise the use and value of social support within telerehabilitation interventions for individuals with MS.Method: A narrative synthesis was conducted. A systematic search of included articles was conducted. Electronic databases were searched from inception to January 2017. Other search methods were undertaken. Evaluation and synthesis of included articles utilised risk of bias assessment and a 4-stage synthesis process.Main Results: A total of fourteen studies, involving 718 participants (505 female, 213 male; aggregated mean age 47.6 years) with MS, were included. Esteem support was the most frequently reported method of social support, followed by informational, emotional and tangible. It would appear social support can be benefi cial in assisting participants to adhere to treatment interventions. Visual feedback may be directly benefi cial to improve impaired balance in individuals with MS. A model for future interventions is provided. Conclusions:Social support appears to increase the adherence of participants with MS to telerehabilitation interventions. Unique fi ndings provide an indication for the direction and content of future interventions. Further research is necessary to ascertain the optimal types and frequencies of social support delivery and its effect on health outcomes for participants with MS.

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Numerical modelling of multiple sclerosis: A tissue-scale model of brain lesions

Hutchison,

Szekely-Kohn,

et al. 2024

Brain Multiphysics

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Experiences of UK health‐care services for people with Multiple Sclerosis: a systematic narrative review

Abstract: Background Multiple Sclerosis (MS) is a chronic, degenerative condition with an estimated UK prevalence of 100 000. Contact with health-care services is frequent and long-term; however, little research has investigated the experiences of health care for MS in the UK.

Cited by 35 publications

References 31 publications

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

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

Determining the use and value of social support in Telerehabiliation Interventions for individuals with Multiple Sclerosis: A narrative synthesis review

Numerical modelling of multiple sclerosis: A tissue-scale model of brain lesions

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