Cost effectiveness of oromucosal cannabis-based medicine (Sativex®) for spasticity in multiple sclerosis.
BACKGROUND
Spasticity is common in patients with multiple sclerosis (MS) and is a major contributor to disability. Sativex®, an oromucosal spray containing cannabis-based medicinal products, has been found to be effective in reducing spasticity symptoms.


OBJECTIVE
Our objective was to estimate the cost effectiveness of Sativex® plus oral anti-spasticity medicines compared with the current standard treatment for moderate or severe spasticity in MS in the UK.


METHODS
A Markov model was used to assess the costs and benefits of Sativex® plus oral anti-spasticity medicines or current standard treatment based on their effects on the quality of life of patients. The main outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per additional QALY gained over 5 years of treatment. One-way, multi-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the findings.


RESULTS
In the base case, Sativex® plus oral anti-spasticity medicines resulted in incremental costs of £7600 and a QALY gain of 0.15 per person over 5 years (ICER = £49 300 per QALY).[year 2009 data for costs]. Findings were sensitive to the costs of Sativex® (price and dose) and differences in utilities between responders and non-responders.


CONCLUSIONS
Using a willingness-to-pay threshold of £30 000 per QALY, Sativex® appears unlikely to be considered cost effective by UK funders of healthcare for spasticity in MS. This is unfortunate, since it appears that Sativex® use is likely to benefit some patients in the management of this common consequence of MS.
Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine and Dentistry, University of Exeter, UK. lulanting@gmail.com
Lanting
L
Lu
Hilary
H
Pearce
Chris
C
Roome
James
J
Shearer
Iain A
IA
Lang
Ken
K
Stein
D058956:Administration, Mucosal; D000284:Administration, Oral; D002185:Cannabidiol; D003362:Cost-Benefit Analysis; D013759:Dronabinol; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000503:physiopathology; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D010936:Plant Extracts / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D006113:United Kingdom
D004338:Drug Combinations; D009125:Muscle Relaxants, Central; D010936:Plant Extracts; D002185:Cannabidiol; D013759:Dronabinol; C587251:nabiximols