title: Cost-effectiveness of disease-modifying therapies in the management of multiple sclerosis for the Medicare population.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) for the management of multiple sclerosis (MS) compared to best supportive care in the United States.
  
  
  METHODS
  Cost-effectiveness analysis was undertaken using a state transition model of disease natural history and the impact of DMTs for the representative Medicare beneficiary with MS. Costs and outcomes were evaluated from the health-care payer perspective using a 50-year time horizon. Natural history data were drawn from a longitudinal cohort study. The effectiveness of the DMTs was evaluated through a systematic review. Utility data were taken from a study of patients with clinically definite MS in Nova Scotia. Resource use and cost data were derived from the Sonya Slifka database and associated literature.
  
  
  RESULTS
  When based on placebo-controlled evidence, the marginal cost-effectiveness of interferon beta (IFNβ) and glatiramer acetate compared to best supportive care is expected to be in excess of $100,000 per quality-adjusted life-year gained. When evidence from head-to-head trials is incorporated into the model, the cost-effectiveness of 6 MIU IFNβ-1a is expected to be considerably less favorable. Treatment discontinuation upon progression to Expanded Disability Status Scale 7.0 is expected to improve the cost-effectiveness of all DMTs.
  
  
  CONCLUSIONS
  Further research is required to examine the long-term clinical effectiveness and cost-effectiveness of these therapies. There is no definitive guidance in the United States concerning discontinuation of DMTs; this study suggests that the prudent use of a treatment discontinuation rule may considerably improve the cost-effectiveness of DMTs.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK. p.tappenden@sheffield.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Tappenden
authors.forename: Christopher
authors.initials: C
authors.lastname: McCabe
authors.forename: Jim
authors.initials: J
authors.lastname: Chilcott
authors.forename: Emma
authors.initials: E
authors.lastname: Simpson
authors.forename: Richard
authors.initials: R
authors.lastname: Nixon
authors.forename: Jason
authors.initials: J
authors.lastname: Madan
authors.forename: John D
authors.initials: JD
authors.lastname: Fisk
authors.forename: Murray
authors.initials: M
authors.lastname: Brown
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D016899:Interferon-beta / Q000191:economics / Q000627:therapeutic use; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D017059:Models, Econometric; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000191:economics* / Q000628:therapy; D009674:Nova Scotia; D010455:Peptides / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States; D028761:Withholding Treatment
chemical_list: D007166:Immunosuppressive Agents; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta