title: Incorporating real-world clinical practice in multiple sclerosis economic evaluations.
abstract: Using evidence from short-term randomized controlled trials, decision-analytic models project costs, risks and benefits of disease-modifying therapies (DMTs) for multiple sclerosis (MS). Such trial-informed models lack the breadth needed to generalize to clinical practice or policy due to limitations: lack of DMT switching/discontinuation, limited head-to-head DMT comparisons and efficacy, not effectiveness, designs. We present an illustrative example that incorporates treatment switching and discontinuation by estimating the cost-effectiveness (value) of first-line natalizumab versus second-line natalizumab treatment for relapsing-remitting MS patients negative for anti-JC virus antibodies. Treating JC virus-negative relapsing-remitting MS patients with natalizumab as first-line provided better value compared with second-line. Decision-makers should consider this evidence for treatment step-edit policies through modeling scenarios closer to clinical practice.
authors: a 1 University of Colorado Anschutz Medical Campus - Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd Aurora, Aurora, CO 80045, USA.
authors: R Brett
authors: RB
authors: McQueen
authors: a 1 University of Colorado Anschutz Medical Campus - Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd Aurora, Aurora, CO 80045, USA.
authors: Kavita V
authors: KV
authors: Nair
authors: b 2 University of Colorado Anschutz Medical Campus - Neurology, Aurora, CO, USA.
authors: Timothy L
authors: TL
authors: Vollmer
authors: a 1 University of Colorado Anschutz Medical Campus - Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 E. Montview Blvd Aurora, Aurora, CO 80045, USA.
authors: Jonathan D
authors: JD
authors: Campbell
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D018803:Models, Economic; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics; D000069442:Natalizumab / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab
keywords: clinical practice; cost–effectiveness; disease-modifying therapy; economic evaluation; multiple sclerosis