Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. Commentary: evaluating disease modifying treatments in multiple sclerosis.
OBJECTIVE
To evaluate the cost effectiveness of four disease modifying treatments (interferon betas and glatiramer acetate) for relapsing remitting and secondary progressive multiple sclerosis in the United Kingdom.


METHODS
Modelling cost effectiveness.


METHODS
UK NHS.


METHODS
Patients with relapsing remitting multiple sclerosis and secondary progressive multiple sclerosis.


METHODS
Cost per quality adjusted life year gained.


RESULTS
The base case cost per quality adjusted life year gained by using any of the four treatments ranged from pound 42,000 (66,469 dollars; 61,630 euro) to pound 98,000 based on efficacy information in the public domain. Uncertainty analysis suggests that the probability of any of these treatments having a cost effectiveness better than pound 20,000 at 20 years is below 20%. The key determinants of cost effectiveness were the time horizon, the progression of patients after stopping treatment, differential discount rates, and the price of the treatments.


CONCLUSIONS
Cost effectiveness varied markedly between the interventions. Uncertainty around point estimates was substantial. This uncertainty could be reduced by conducting research on the true magnitude of the effect of these drugs, the progression of patients after stopping treatment, the costs of care, and the quality of life of the patients. Price was the key modifiable determinant of the cost effectiveness of these treatments.
Chilcott
Jim
J
School of Health and Related Research Rapid Reviews Group, School of Health and Related Research, University of Sheffield.
McCabe
Chris
C
Tappenden
Paul
P
O'Hagan
Anthony
A
Cooper
Nicola J
NJ
Abrams
Keith
K
Claxton
Karl
K
Miller
David H
DH
D003362:Cost-Benefit Analysis; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use; D016899:Interferon-beta / Q000191:economics* / Q000627:therapeutic use; D020528:Multiple Sclerosis, Chronic Progressive / Q000188:drug therapy* / Q000191:economics; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics; D015999:Multivariate Analysis; D010455:Peptides / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D007155:Immunologic Factors; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta