Cost effectiveness of recombinant human insulin-like growth factor I therapy in patients with ALS.
OBJECTIVE
Amyotrophic lateral sclerosis (ALS) is a fatal, degenerative neuromuscular disease characterised by a progressive loss of voluntary motor activity. Recombinant human insulin-like growth factor I (rhIGF-I) has been shown to be useful in treating ALS. The purpose of this study was to examine the cost effectiveness of rhIGF-I therapy in patients who have ALS.


METHODS
We performed a cost-effectiveness analysis from the societal perspective on 177 patients who received treatment with rhIGF-I or placebo in a North American randomised clinical trial. We estimated the incremental cost-effectiveness ratio of rhIGF-I using resource utilisation and functional status measurements from the clinical trial. Costs were estimated from 1996 US Medicare reimbursement schedules. Utility weights were elicited from ALS healthcare providers using the standard gamble technique.


RESULTS
The overall cost per quality-adjusted life-year (QALY) gained for rhIGF-I therapy compared with placebo was $US67,440. For the subgroups of patients who were progressing rapidly or were in earlier stages of disease at enrolment, rhIGF-I cost $US52,823 and $US43,197 per QALY gained, respectively.


CONCLUSIONS
Treatment with rhIGF-I is most cost effective in ALS patients who are either in earlier stages of the disease or progressing rapidly. The cost effectiveness of rhIGF-I therapy compares favourably with treatments for other chronic progressive diseases.
Ackerman
S J
SJ
Covance Health Economics and Outcomes Services Inc., Washington, DC, USA. stacey.ackerman@covance.com
Sullivan
E M
EM
Beusterien
K M
KM
Natter
H M
HM
Gelinas
D F
DF
Patrick
D L
DL
D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011994:Recombinant Proteins / Q000191:economics* / Q000627:therapeutic use*; D012680:Sensitivity and Specificity
D011994:Recombinant Proteins; D007334:Insulin-Like Growth Factor I