OBJECTIVES

This study aimed to investigate the consistency of economic considerations of biologic disease-modifying anti-rheumatic drugs (bDMARDs) for multiple sclerosis (MS) treatment across different jurisdictions and explore the underlying value thresholds that are considered by the HTA agencies in real-world settings.

METHODS

We performed a review of the published HTA recommendations for bDMARDs in the treatment of MS from four major HTA agencies. PBAC, CADTH, SMC, and NICE were selected as these are key HTA agencies that adopt similar value and evidence-based decision-making model. Key issues surrounding the economic evaluation of the medicines were analysed for all bDMARDs for MS treatment considered between 2011 and 2018 by these agencies. Different currencies were converted and discounted to make comparisons among the agencies.

RESULTS

Since 2011, the HTA agencies have recommended multiple new disease-modifying therapies for the treatment of multiple sclerosis, which provides a good model to study the up-to-date decision-making mechanism for innovative and high-cost medicines. The key areas we explored include the threshold, consistency across decision-making in the same class of medicines, and the key considerations of the economic model. In the majority of the cases, the same comparators were selected by different agencies to support economic assessment; however, the reported ICER values underpinning the HTA recommendations demonstrated significant variations across agencies. We also noted the lack of transparency of economic analysis in the public HTA reports across agencies, which made it difficult to find factors that are considered as universal values across jurisdictions

CONCLUSIONS

There are inconsistency across jurisdictions on the economic evaluation of medicines that underpinning the decisions made by the HTA agencies. The findings from this study could either urge better alignment across HTA agencies or inform the drug developers to be aware of these issues and appropriately set up global HTA strategy.