OBJECTIVES: To evaluate the cost-effectiveness of an intensive cognitive theory-based intervention (CanDo treatment [CDT]), compared to care-as-usual in patients with relapsing remitting multiple sclerosis (RRMS) and low disability (Expanded Disability Status Scale [EDDS] score < 4.0) at 6 months.

METHODS: This trial-based economic evaluation (EE) was performed from a societal perspective. The Dutch guidelines for performing EEs in health-care were followed. Both health-care and none-health care costs, measured by means of online questionnaires, were taken into account. The incremental cost utility ratio (ICUR) in the cost per Quality Adjusted Life Years (QALY) using the EQ-5D-5L and the incremental cost effectiveness ratio (ICER) in cost per control subscale of the Multiple Sclerosis Self-Efficacy Scale (MSSES) were calculated. Extensive sensitivity and subgroup analyses were performed to determine the robustness of the findings.

RESULTS: The two groups of 79 patients were similar in baseline characteristics. The base case ICUR is situated in the northwest (inferior) quadrant due to losses in QALY and higher societal costs for the CDT group (-.02/€2,948). The ICER is situated in the northeast quadrant (€72 (40.74/€2,948)) due to a higher MSSES control and higher societal costs in the CDT group. In general, both the sensitivity and subgroup analyses confirm the base case findings. However, when the SF-6D is used, there is a high probability that the ICUR is situated in the same quadrant as the base case ICER.

CONCLUSIONS: When using the EQ-5D-5L to calculate a QALY, CDT is not a cost-effective alternative in comparison to care as usual. However, when using MSSES control or SF-6D as outcomes, there is a probability that CDT is cost-effective. Based on the current results, CDT for patients with RRMS clearly show its potential. However, an extended follow up for the EE is warranted before a final decision on implementation can be made.