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Cost-effectiveness of disease-modifying therapy for multiple sclerosis: a population-based study.
K Noyes1, A Bajorska, A Chappel
1Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Ave., Box 644, Rochester, NY 14620, USA. katia_noyes@urmc.rochester.edu
Neurology
|July 22, 2011
Summary
Disease-modifying therapies (DMTs) for relapsing multiple sclerosis (MS) offer modest health gains but at a very high cost, exceeding $800,000 per quality-adjusted life-year (QALY). Earlier treatment initiation improves cost-effectiveness.
Area of Science:
- Health Economics
- Neurology
- Pharmacoeconomics
Background:
- Relapsing multiple sclerosis (MS) significantly impacts patients' quality of life and economic productivity.
- Disease-modifying therapies (DMTs) are available for MS, but their cost-effectiveness remains a critical consideration for healthcare systems.
Purpose of the Study:
- To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) in the United States for patients with relapsing multiple sclerosis (MS).
- To compare the economic value of DMTs against basic supportive therapy without DMT.
Main Methods:
- Longitudinal MS survey data was used to generate 10-year disease progression paths.
- First-order annual Markov models estimated transitional probabilities, incorporating medical costs and costs of employment loss.
- Quality-adjusted life-years (QALYs) and relapse-free years were primary outcome measures, with Monte Carlo simulations assessing model uncertainty.
Main Results:
- All DMTs demonstrated modest health gains (0.082-0.192 QALY) over 10 years compared to no DMT, with cost-effectiveness ratios exceeding $800,000/QALY.
- Significant cost reductions in DMTs were crucial for improving cost-effectiveness; a 67% reduction could make Avonex potentially cost-effective at $164,000/QALY.
- Initiating DMT earlier in the disease course was associated with more favorable incremental cost-effectiveness ratios.
Conclusions:
- Disease-modifying therapies for MS provide incremental health benefits but at a substantial economic cost.
- The high cost of current DMTs challenges their cost-effectiveness in the US healthcare system.
- Earlier initiation of DMTs may offer a more favorable economic profile compared to later treatment.
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