[Cost-utility analysis of relapsing-remitting multiple sclerosis treatment with azathioprine or interferon beta in Spain].
OBJECTIVE
To carry out a cost-utility analysis of the treatment of relapsing-remitting multiple sclerosis (RRMS) with azathioprine (Imurel) or beta interferon (all, Avonex, Rebif and Betaferon).


METHODS
Pharmacoeconomic Markov model comparing treatment options by simulating the life of a hypothetical cohort of women aged 30, from the societal perspective. The transition probabilities, utilities, resource utilisation and costs (direct and indirect) were obtained from Spanish sources and from bibliography. Univariant sensitivity analyses of the base case were performed.


RESULTS
In the base case analysis, the average cost per patient (euros in 2003) of a life treatment, considering a life expectancy of 53 years, would be 620,205, 1,047,836, 1,006,014, 1,161,638 and 968,157 euros with Imurel, all interferons, Avonex, Rebif and Betaferon, respectively. Therefore, the saving with Imurel would range between 327,000 and 520,000 euros approximately. The quality-adjusted life years (QALY) obtained with Imurel or interferons would be 10.08 and 9.30, respectively, with an average gain of 0.78 QALY per patient treated with Imurel. The sensitivity analyses confirmed the robustness of the base case. The cost of one additional QALY with interferons would range between 413,000 and 1,308,000 euros approximately in the hypothetical worst scenario for Imurel.


CONCLUSIONS
For a typical patient with RRMS, treatment with Imurel would be more efficient than interferons and would dominate (would be more efficacious with lower costs) beta interferon.
HERO Consulting, Health Economics and Research of Outcomes, Virgen de Aránzazu 21, E-28034 Madrid, Spain. carlosrubio1@wanadoo.es
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Rubio-Terrés
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Domínguez-Gil Hurlé
D000276:Adjuvants, Immunologic / Q000191:economics* / Q000627:therapeutic use*; D001379:Azathioprine / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use*; D016899:Interferon-beta / Q000191:economics* / Q000627:therapeutic use*; D008136:Longevity; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics*; D013030:Spain
D000276:Adjuvants, Immunologic; D007166:Immunosuppressive Agents; D016899:Interferon-beta; D001379:Azathioprine