title: Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis.
abstract: OBJECTIVE
  To perform a cost-effectiveness analysis of three immunomodulatory treatments for newly diagnosed nonprimary progressive MS: interferon beta-1a, interferon beta-1b, and glatiramer acetate.
  
  
  METHODS
  We developed a state-transition model to estimate the health effects and costs associated with interferon beta-1a, interferon beta-1b, glatiramer acetate, and no treatment for hypothetical cohorts of men and women with non-primary progressive MS. We used the Expanded Disability Status Scale as the measure of disability and included both relapses and disease progression in the model. We evaluated treatment strategies assuming a 10-year treatment duration using the societal perspective. We elicited preferences for disability and treatment states using standard-gamble questions and modeled the disutility associated with treatment administration and side effects explicitly. Main outcome measures were net gains in quality-adjusted life expectancy and incremental cost-effectiveness ratios in dollars per quality-adjusted life year (QALY) gained.
  
  
  RESULTS
  For treatment duration of 10 years for newly diagnosed non-primary progressive MS, interferon beta-1a yielded the largest gain in quality-adjusted life expectancy with an incremental cost-effectiveness ratio of $2,200,000/QALY for women and $1,800,000/QALY for men, compared with no treatment. For a 5-year treatment duration, a "no treatment" strategy yielded more quality-adjusted life years than any of the treatment strategies. Cost-effectiveness ratios were similar for all three immunomodulatory treatments evaluated.
  
  
  CONCLUSIONS
  Cost-effectiveness results for all three immunomodulatory treatments for MS were unfavorable in the simulated study population under a wide range of assumptions. For treatment duration less than or equal to 5 years, expected benefits of treatment may not outweigh disutility associated with side effects and treatment discomfort.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA. lprosser@hms.harvard.edu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Amit
authors.initials: A
authors.lastname: Bar-Or
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
mesh_terms: D000276:Adjuvants, Immunologic / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics*; D004185:Disability Evaluation; D018450:Disease Progression; D017850:Economics, Pharmaceutical; D005260:Female; D000068717:Glatiramer Acetate; D006801:Humans; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D009010:Monte Carlo Method; D009103:Multiple Sclerosis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010455:Peptides / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years
chemical_list: D000276:Adjuvants, Immunologic; D010455:Peptides; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D000068556:Interferon beta-1a