Literature Monitor

How Cost-Effective Are Disease-Modifying Therapies in MS?
Disease-modifying therapies (DMTs) for relapsing-remitting or secondary progressive multiple sclerosis (MS) do not appear to be cost-effective in the United States, according to findings published online July 20 by Neurology.
Katia Noyes, PhD, MPH, of the University of Rochester, New York, and colleagues calculated the cost-effectiveness of four DMTs in a nationally representative cohort of 1,121 patients with MS. The investigators generated 10-year disease progression paths for this cohort; looked at data on drug effectiveness, patient health preferences, health care use, lost productivity, and medical costs; measured health gains in quality-adjusted life-years (QALYs) and relapse-free years; and calculated incremental cost-effectiveness ratios (ICERs). The DMTs studied were glatiramer acetate, intramuscular interferon beta-1a, subcutaneous interferon beta-1a, and interferon beta-1b.
DMT therapy for 10 years resulted in modest QALY gains (0.082 for glatiramer acetate and 0.126 to 0.192 for the interferons), compared with basic supportive therapy. In addition, DMT therapy resulted in more relapse-free years throughout the course of a decade; patients on basic therapy averaged 5.051 relapse-free years, compared with 5.879 relapse-free years for glatiramer acetate and 5.620 to 6.074 relapse-free years for the interferons.
However, the ICERs of all four DMTs far exceeded $800,000 per QALY gained. The interferons had similar ICERs, at $901,319/QALY for intramuscular interferon beta-1a, $1,487,306/QALY for subcutaneous interferon beta-1a, and $1,123,162/QALY for interferon beta-1b. The ICER for glatiramer acetate was significantly higher, at $2,178,555/QALY. “While there is no formal cost-effectiveness threshold in the US, these estimates are an order of magnitude greater than the cost-effectiveness of many commonly accepted therapies for chronic illness,” the researchers commented.
The researchers added that cutting DMT costs by two-thirds would make the therapies’ cost-effectiveness comparable to that of other accepted interventions, however. In addition, the investigators noted that starting DMT earlier was associated with a more favorable ICER, compared with initiating treatment at any disease state, and that early treatment “may defer the substantial costs associated with late-stage MS and disability.”
Noyes K, Bajorska A, Chappel A, et al. Cost-effectiveness of disease-modifying therapy for multiple sclerosis: a population-based study. Neurology. 2011 Jul 20; [Epub ahead of print].