How have Economic Evaluations in Relapsing Multiple Sclerosis Evolved Over Time? A Systematic Literature Review

Abstract

Introduction: The introduction of diseasemodifying therapies (DMTs) for relapsing multiple sclerosis (RMS) over the last two decades has prompted the economic assessments of these treatments by reimbursement authorities. The aim of this systematic literature review was to evaluate the modeling approach and data sources used in economic evaluations of DMTs for RMS, identify differences and similarities, and explore how economic evaluation models have evolved over time. Methods: MEDLINEÒ, EmbaseÒ, and EBM Reviews databases were searched using OvidÒ Platform from database inception on 25 December 2019 and subsequently updated on 17 February 2021. In addition, health technology assessment agency websites, key conference proceedings, and gray literature from relevant

Societal economic burden of multiple sclerosis and cost-effectiveness of disease-modifying therapies

“…Caution needs to be exercised when interpreting these results on the cost-effectiveness of DMTs in light of methodological limitations of existing economic evaluations. Based on the literature ( 24 , 26 , 27 , 29 – 31 ), Table 1 identifies several methodological challenges when calculating the cost-effectiveness of DMTs and provides recommendations on how to address these challenges. In particular, future economic evaluations need to draw on contemporary natural disease progression data, model the cost-effectiveness of DMT sequences, and account for the broader impact of MS interventions on patient well-being ( 24 , 29 , 31 , 32 ).…”

“… Author's table based on Hernandez et al ( 24 ), Thompson et al ( 26 ), Guo et al ( 27 ), Wiyani et al ( 29 ), Yamamoto and Campbell ( 30 ), and Hawton et al ( 31 ). DMT, disease-modifying therapy; EDSS, Expanded Disability Status Scale; MS, multiple sclerosis; QALY, quality-adjusted life year; RCT, randomized controlled trial; RWE, real-world evidence.…”

“…Author's table based on Hernandez et al ( 24 ), Thompson et al ( 26 ), Guo et al ( 27 ), Wiyani et al ( 29 ), Yamamoto and Campbell ( 30 ), and Hawton et al ( 31 ).…”

“…Many economic evaluations of DMTs are funded by pharmaceutical industry ( 29 ) in the context of a reimbursement application. A review of appraisals of DMTs for relapsing-remitting MS conducted by health technology assessment agencies in seven OECD countries found that reimbursement recommendations for the same product vary between agencies as a result of differences in how agencies assess cost-effectiveness and appraise evidence ( 33 ).…”

A US payer perspective health economic model assessing value of monitoring disease activity to inform discontinuation and re-initiation of DMT in multiple sclerosis

“…Previous economic analyses have discussed the concept of DMT effect waning over time. In a meta-analysis done by Wiyani et al, 27 12 economic evaluations and 12 health technology assessments (HTAs) assumed a treatment-waning effect up to 25%-75% after 2 years and 50% after 5 years of DMT. Another study by Simoens 28 examining the health economic facets of MS stated that depending on the setting of the economic evaluation.…”