COST-EFFICACY ANALYSIS OF MULTIPLE SCLEROSIS THERAPIES- ASSESSING THE IMPACT OF NEUTRALIZING ANTIBODIES
Author(s)
Frederick Munschauer, MD, Chair, Department of Neurology1, Thomas Baker, MPA, Vice President, Strategy and Analytics2, Jeffrey Dunn, PharmD, MBA, Formulary and Contract Manager3, Richard Cook, PharmD, Pharmacy Manager, Quality & Clinical Programs4, William Likosky, MD, Chair, Neurology Department5, Dusan Stefoski, MD, Associate Professor of Neurology61State University of New York at Buffalo, Buffalo, NY, USA; 2 The Zitter Group, San Francisco, CA, USA; 3 IHC Health Plans, Salt Lake City, UT, USA; 4 Blue Care Network of Michigan, Grand Rapids, MI, USA; 5 Swedish Medical Center, Seattle, WA, USA; 6 Rush University Medical Center, Chicago, IL, USA
OBJECTIVE: To determine the effect of neutralizing antibodies (NAbs) on the cost-effectiveness of disease-modifying agents (DMAs) used to treat multiple sclerosis (MS). METHODS: A cost-effectiveness model was developed using relapse rate and disability progression endpoints from pivotal phase III trials of currently approved DMAs for MS (interferon beta [IFNΒ]-1a IM [Avonex], IFNΒ-1a SC [Rebif], IFNΒ-1b [Betaseron], and glatiramer acetate [GA; Copaxone]). The model was created from a managed care perspective with time horizons of 24 and 48 months. Cost-effectiveness is expressed as a ratio of total utilization costs per percent relative risk reduction for relapses and disability progression; daily cost-effectiveness is shown as per percentage point reduction. The incidence of NAbs and their effect on efficacy was obtained from prescribing information, open-label extension studies of IFNΒ products, and a large population study. The model includes the following assumptions: comparison of similar endpoints across different clinical trials; constant adverse event rates among products; constant burden of relapse over time; constant persistence/compliance rates among products; similar laboratory testing/frequency among IFNΒ products. A one-way sensitivity analysis was conducted to test the robustness of the model to changes in NAb incidence. RESULTS: At 24 months, the cost-effectiveness for disability progression was $824 ($1.13/day) for IFNΒ-1a IM, $1222 ($1.67/day) for IFNΒ-1a SC, $1150 ($1.57/day) for IFNΒ-1b, and $2558 ($3.50/day) for GA. After the development of NAbs, at 48 months cost-effectiveness was $1659 ($1.14/day) for IFNΒ-1a IM, $2536 ($1.74/day) for IFNΒ-1a SC, $2433 ($1.67/day) for IFNΒ-1b, and $5117 ($3.50/day) for GA. Results were similar for relapse rate. Results of sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: NAbs reduce the cost-effectiveness of IFNΒ products. IFNΒ-1a IM (Avonex) was the most cost-efficacious DMA before (24 months) and after (48 months) the development of NAbs.
Conference/Value in Health Info
2006-05, ISPOR 2006, Philadelphia, PA
Value in Health, Vol. 9, No.3 (May/June 2006)
Code
PNL7
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Neurological Disorders
Explore Related HEOR by Topic
