Impact on the Incremental Cost-Effectiveness Ratio of Using Alternatives to EQ-5D in a Markov Model for Multiple Sclerosis.
This study responds to a request in the National Institute for Health and Care Excellence (NICE) guidance to assess the impact of using alternative sources of utility values, applied to multiple sclerosis (MS).



Incremental cost-effectiveness ratios (ICERs) were calculated using utility values based on UK and Dutch values of EQ-5D, two UK mappings and one Dutch mapping of EQ-5D and two condition-specific instruments: the UK eight-dimensional Multiple Sclerosis Impact Scale (MSIS-8D) and the Dutch Multiple Sclerosis Impact Scale Preference-Based Measure (MSIS-PBM). Deterministic and Monte-Carlo simulation-based ICERs were estimated for glatiramer acetate versus symptom management using a lifetime Markov model.



For both UK and Dutch perspectives, mapped and condition-specific utility values expressed significantly higher quality of life for the worst health state of the model than did EQ-5D. The ICER of glatiramer acetate with EQ-5D was US$182,291 for The Netherlands and US$153,476 for the UK. Ratios for mapped and condition-specific utilities were between 20 and 60 % higher.



The overestimation of quality of life of patients with MS by mapped EQ-5D or condition-specific utility values, relative to observed EQ-5D, increases the ICER substantially in a lifetime Markov model.
Institute for Medical Technology Assessment, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, The Netherlands. versteegh@imta.eur.nl.
Matthijs
M
Versteegh
D000276:Adjuvants, Immunologic / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D000068717:Glatiramer Acetate / Q000191:economics / Q000627:therapeutic use*; D006304:Health Status; D006801:Humans; D008390:Markov Chains; D009103:Multiple Sclerosis / Q000191:economics* / Q000503:physiopathology / Q000628:therapy; D009426:Netherlands; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000276:Adjuvants, Immunologic; D000068717:Glatiramer Acetate