Disease modifying therapies in multiple sclerosis: cost-effectiveness systematic review

Area of Science:

• Pharmacoeconomics
• Neurology
• Health Services Research

Background:

• Relapsing-remitting multiple sclerosis (RRMS) necessitates evaluating the economic value of disease-modifying therapies (DMTs).
• Numerous DMTs are available, each with varying costs and clinical effectiveness, prompting cost-effectiveness analyses.

Purpose of the Study:

• To systematically review and describe cost-effectiveness studies of DMTs for RRMS.
• To identify methodological strengths and weaknesses in existing economic evaluations of RRMS treatments.

Main Methods:

• Systematic literature review of cost-effectiveness analyses from 2010-2017.
• Searched multiple databases including MEDLINE, Embase, Cochrane Library, and specialized economic evaluation registries.
• Assessed study quality using the Quality of Health Economic Studies (QHES) instrument.

Main Results:

• Nine studies were included, exhibiting substantial methodological variability.
• Some studies indicated no first-line therapy was cost-effective, while others showed dominance for interferon beta-1b and teriflunomide.
• Second- and third-line analyses presented mixed results for dimethyl fumarate, natalizumab, and alemtuzumab, with noted sponsorship bias in many trials.

Conclusions:

• Cost-effectiveness studies for RRMS DMTs display high methodological variability and often yield contradictory findings.
• The current evidence base does not permit a definitive conclusion on the most cost-effective DMT for RRMS.