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A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
Implications of real-world adherence on cost-effectiveness analysis in multiple sclerosis
David W Brandes1, Karina Raimundo, Neetu Agashivala
1Hope MS Center, Knoxville, TN, USA.
Journal of Medical Economics
|February 9, 2013
Summary
Medication adherence significantly impacts multiple sclerosis (MS) treatment costs and outcomes. Real-world adherence data, not just trial efficacy, is crucial for accurately assessing the economic value of MS therapies.
Area of Science:
- Pharmacoeconomics
- Neurology
- Health Services Research
Background:
- Medication adherence is critical for managing chronic conditions like multiple sclerosis (MS).
- Lower adherence in MS is linked to increased relapses, hospitalizations, and healthcare costs.
- Previous economic models for MS therapies often assumed 100% adherence, not reflecting real-world usage.
Purpose of the Study:
- To assess the impact of real-world medication adherence on the cost-effectiveness of disease-modifying therapies (DMTs) for multiple sclerosis (MS) from a US payer perspective.
- To update previous cost-per-relapse-avoided analyses by incorporating real-world adherence data and current costs.
Main Methods:
- A pharmacoeconomic model was developed to evaluate the cost per relapse avoided for various first-line DMTs in MS.
- The model incorporated real-world adherence rates derived from a large claims database, unlike previous models assuming perfect adherence.
- Updated cost data and adherence-adjusted efficacy estimates were used to reflect actual clinical practice.
Main Results:
- Fingolimod demonstrated the lowest cost per relapse avoided ($90,566), followed by other DMTs including SC IFN β-1b, SC IFN β-1a, glatiramer acetate, and IM IFN β-1a.
- Key drivers of the results included the adherence-adjusted relative relapse rate reduction for fingolimod, its wholesale acquisition cost, and the relapse rate in untreated MS patients.
- The analysis highlighted the significant influence of adherence on the economic value of MS treatments.
Conclusions:
- Economic analyses of MS therapies should integrate real-world adherence rates to accurately determine treatment value.
- Highly effective therapies may show substantially lower real-world efficacy than clinical trials suggest if adherence is poor.
- Limitations include reliance on a single claims database for adherence estimates and exclusion of manufacturer discounts/rebates.
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