Economic evaluation of Avonex (interferon beta-Ia) in patients following a single demyelinating event.
BACKGROUND
Interferon beta-Ia (Avonex) 30 microg, intramuscular (i.m.), once weekly is efficacious in delaying clinically definite multiple sclerosis (CDMS) following a single demyelinating event (SDE). This study determined the cost effectiveness of Avonex compared to current treatment in delaying the onset of CDMS.


METHODS
A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) were performed from Ministry of Health (MoH) and societal perspectives. For CEA, the outcome of interest was time spent in the pre-CDMS state, termed monosymptomatic life years (MLY) gained. For CUA, the outcome was quality-adjusted monosymptomatic life years (QAMLY) gained. A Markov model was developed with transitional probabilities and utilities derived from the literature. Costs were reported in 2002 Canadian dollars. Costs and outcomes were discounted at 5%. The time horizon was 12 years for the CEA, and 15 years for the CUA. All uncertainties were tested via univariate and multivariate sensitivity analyses.


RESULTS
In the CEA, the incremental cost of Avonex per ILYgained was $53110 and $44789 from MoH and societal perspectives, respectively. In the CUA, the incremental cost of Avonex per QAMLY gained was $227586 and $189286 from MoH and societal perspectives, respectively. Both models were sensitive to the probability of progressing to CDMS and the analytical time horizon. The CUA was sensitive to the utilities value.


CONCLUSIONS
Avonex may be considered as a reasonably cost-effective approach to treatment of patients experiencing an SDE In addition, the overall incremental cost-effectiveness profile of Avonex improves if treatment is initiated in pre-CDMS rather than waiting until CDMS.
Iskedjian
Michael
M
PharmIdeas Research and Consulting Inc., 1175 North Service Road West, Suite 211, Oakville, Ontario, Canada. skedji@pharmideas.com
Walker
John H
JH
Gray
Trevor
T
Vicente
Colin
C
Einarson
Thomas R
TR
Gehshan
Adel
A
D000276:Adjuvants, Immunologic / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D003362:Cost-Benefit Analysis; D003711:Demyelinating Diseases / Q000188:drug therapy* / Q000191:economics; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data; D006801:Humans; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000191:economics* / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000191:economics; D015999:Multivariate Analysis; D011788:Quality of Life
D000276:Adjuvants, Immunologic; D016899:Interferon-beta; D000068556:Interferon beta-1a