title: Cost-effectiveness analysis of peginterferon beta-1a compared with interferon beta-1a and glatiramer acetate in the treatment of relapsing-remitting multiple sclerosis in the United States.
abstract: Objective Peginterferon beta-1a 125 mcg, administered subcutaneously (SC) every 2 weeks, a new disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS), was approved by the US Food and Drug Administration in 2014. This study assesses the cost-effectiveness of peginterferon beta-1a vs interferon beta-1a (44 mcg SC 3 times per week) and glatiramer acetate (20 mg SC once-daily) in the treatment of RRMS from the perspective of a US payer over 10 years. Methods A Markov cohort economic model was developed for this analysis. The model predicts disability progression, occurrence of relapses and other adverse events and translates them into quality-adjusted life years (QALYs) and costs. Natural history data were obtained from the placebo arm of the ADVANCE trial of peginterferon beta-1a, the London Ontario (Canada) database and a large population-based MS survey. Comparative efficacy of each DMT vs placebo was obtained from a network meta-analysis. Costs (in 2014 US dollars) were sourced from public databases and literature. Clinical and economic outcomes were discounted at 3% per year. Results Over 10 years, peginterferon beta-1a was dominant (i.e., more effective and less costly), with cost-savings of $22,070 and additional 0.06 QALYs when compared with interferon beta-1a 44 mcg and with cost-savings of $19,163 and 0.07 QALYs gained when compared with glatiramer acetate 20 mg. Results were most sensitive to variations in the treatment effect of each DMT, treatment acquisition costs of each DMT and the time horizon. Probabilistic sensitivity analyses indicated that peginterferon beta-1a remains dominant in >90% of 5,000 replications compared with either DMTs. Conclusion This analysis suggests that long-term treatment with peginterferon beta-1a improves clinical outcomes at reduced costs compared with interferon beta-1a 44 mcg and glatiramer acetate 20 mg and should be a valuable addition to managed care formularies for treating patients with RRMS.
authors.affiliation: a Evidera , 430 Bedford St. Suite 300 , Lexington , MA 02420 , USA ;
authors.forename: Luis
authors.initials: L
authors.lastname: Hernandez
authors.affiliation: a Evidera , 430 Bedford St. Suite 300 , Lexington , MA 02420 , USA ;
authors.forename: Shien
authors.initials: S
authors.lastname: Guo
authors.affiliation: b Biogen , Landis & Gyr-Strasse 3 , 6300 Zug , Switzerland ;
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kinter
authors.affiliation: c Biogen , 133 Boston Post Road , Weston , MA 02493 , USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Fay
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D000068717:Glatiramer Acetate / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D000068556:Interferon beta-1a / Q000191:economics* / Q000627:therapeutic use; D016899:Interferon-beta / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D017059:Models, Econometric; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000191:economics; D011092:Polyethylene Glycols / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D011092:Polyethylene Glycols; D000068717:Glatiramer Acetate; D016899:Interferon-beta; C428112:peginterferon beta-1a; D000068556:Interferon beta-1a
keywords: Peginterferon beta-1a – Cost-effectiveness – Multiple sclerosis – United States