Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: a Markov model based on data a Balkan country in socioeconomic transition.
OBJECTIVE
A cost-effectiveness analyses of immunomodulatory treatments for relapsing-remitting multiple sclerosis (RRMS) in developed countries have shown that any benefit from these drugs is achieved at very high cost. The aim of our study was to compare the cost-effectiveness of five treatment strategies in patients diagnosed with RRMS (symptom management alone and in combination with subcutaneous glatiramer acetate, intramuscular interferon beta-1a, subcutaneous interferon beta-1a, or intramuscular interferon [beta-1b) in a Balkan country in socio-economic transition.


METHODS
The Markov model was developed based on the literature about effectiveness and on local Serbian cost calculations. The duration of a cycle in the model was set to a month. The baseline time horizon was 480 months (40 years). The societal perspective was used for costs and outcomes, and they were discounted for 3% annually. Monte Carlo micro simulation with 1000 virtual patients was done.


RESULTS
Significant gain with immunomodulatory therapy was achieved only in relapse-free years, while the time spent in health states EDSS 0.0-5.5 was longer with symptomatic therapy only, and gains in life years and QALYs were only marginal. One QALY gained costs more than a billion of Serbian dinars (more than 20 million US dollars), making each of the four immunomodulatory therapies cost-ineffective.


CONCLUSIONS
Our study suggests that immunomodulatory therapy of RRMS in a Balkan country in socioeconomic transition is not cost-effective, regardless of the type of the therapy. Moderate gain in relapse-free years does not translate to gain in QALYs, probably due to adverse effects of immunomodulatory therapy.
Janković
Slobodan M
SM
University of Kragujevac, Medical Faculty, Ul. Svetozara Markovića 69, 34 000 Kragujevac, Serbia. slobnera@eunet.rs
Kostić
Marina
M
Radosavljević
Marija
M
Tesić
Danka
D
Stefanović-Stoimenov
Natasa
N
Stevanović
Ivan
I
Raković
Sladana
S
Aleksić
Jelena
J
Folić
Marko
M
Aleksić
Aleksandra
A
Mihajlović
Ivana
I
Biorac
Nenad
N
Borlja
Jelena
J
Vucković
Radosava
R
D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D000068717:Glatiramer Acetate; D006801:Humans; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000008:administration & dosage* / Q000191:economics*; D008390:Markov Chains; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics*; D010455:Peptides / Q000008:administration & dosage* / Q000191:economics; D019057:Quality-Adjusted Life Years; D055771:Serbia
D000276:Adjuvants, Immunologic; D010455:Peptides; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D000068556:Interferon beta-1a